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Kitagawa Y, Matsuda S, Gotoda T, Kato K, Wijnhoven B, Lordick F, Bhandari P, Kawakubo H, Kodera Y, Terashima M, Muro K, Takeuchi H, Mansfield PF, Kurokawa Y, So J, Mönig SP, Shitara K, Rha SY, Janjigian Y, Takahari D, Chau I, Sharma P, Ji J, de Manzoni G, Nilsson M, Kassab P, Hofstetter WL, Smyth EC, Lorenzen S, Doki Y, Law S, Oh DY, Ho KY, Koike T, Shen L, van Hillegersberg R, Kawakami H, Xu RH, Wainberg Z, Yahagi N, Lee YY, Singh R, Ryu MH, Ishihara R, Xiao Z, Kusano C, Grabsch HI, Hara H, Mukaisho KI, Makino T, Kanda M, Booka E, Suzuki S, Hatta W, Kato M, Maekawa A, Kawazoe A, Yamamoto S, Nakayama I, Narita Y, Yang HK, Yoshida M, Sano T. Clinical practice guidelines for esophagogastric junction cancer: Upper GI Oncology Summit 2023. Gastric Cancer 2024; 27:401-425. [PMID: 38386238 PMCID: PMC11016517 DOI: 10.1007/s10120-023-01457-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/09/2023] [Indexed: 02/23/2024]
Affiliation(s)
- Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
| | - Satoru Matsuda
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Takuji Gotoda
- Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ken Kato
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Bas Wijnhoven
- Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Florian Lordick
- Department of Oncology and University Cancer Center Leipzig, Leipzig University Medical Center, Comprehensive Cancer Center Central, Leipzig, Jena, Germany
| | - Pradeep Bhandari
- Department of Gastroenterology, Portsmouth University Hospital NHS Trust, Portsmouth, UK
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Kei Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Paul F Mansfield
- Surgical Oncology, University of Texas, MD Anderson Cancer Center, Houston, USA
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Jimmy So
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Stefan Paul Mönig
- Upper-GI-Surgery University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland
| | - Kohei Shitara
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Sun Young Rha
- Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yelena Janjigian
- Department of Medicine, Solid Tumor Gastrointestinal Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Daisuke Takahari
- Gastroenterological Chemotherapy, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ian Chau
- Department of Medicine, Royal Marsden Hospital, London, UK
| | - Prateek Sharma
- Division of Gastroenterology, School of Medicine and VA Medical Center, University of Kansas, Kansas, USA
| | - Jiafu Ji
- Department of Gastrointestinal Surgery, Peking University Cancer Hospital, Beijing, China
| | - Giovanni de Manzoni
- Department of Surgery, Dentistry, Maternity and Infant, University of Verona, Verona, Italy
| | - Magnus Nilsson
- Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Paulo Kassab
- Gastroesophageal Surgery, Santa Casa of Sao Paulo Medical School, São Paulo, Brazil
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, University of Texas, MD Anderson Cancer Center, Houston, USA
| | | | - Sylvie Lorenzen
- Department of Hematology and Oncology, Klinikum Rechts Der Isar Munich, Munich, Germany
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Simon Law
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
| | - Do-Youn Oh
- Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Khek Yu Ho
- National University of Singapore, Singapore, Singapore
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Lin Shen
- Department of Gastrointestinal Oncology, Peking University Cancer Hospital, Beijing, China
| | - Richard van Hillegersberg
- Department of Upper Gastrointestinal Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hisato Kawakami
- Department of Medical Oncology, Faculty of Medicine, Kindai University, Higashiosaka, Japan
| | - Rui-Hua Xu
- Department of Medical Oncology, Sun YAT-Sen University Cancer Center, Guangzhou, China
| | - Zev Wainberg
- Gastrointestinal Medical Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Naohisa Yahagi
- Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Rajvinder Singh
- Department of Gastroenterology, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Min-Hee Ryu
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Ryu Ishihara
- Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Zili Xiao
- Digestive Endoscopic Unit, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Chika Kusano
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Heike Irmgard Grabsch
- Department of Pathology, GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands
- Pathology & Data Analytics, Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Hiroki Hara
- Gastroenterology, Saitama Cancer Center, Saitama, Japan
| | - Ken-Ichi Mukaisho
- Education Center for Medicine and Nursing, Shiga University of Medical Science, Otsu, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Mitsuro Kanda
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eisuke Booka
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Sho Suzuki
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Motohiko Kato
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Akira Maekawa
- Department of Gastroenterology, Osaka Police Hospital, Osaka, Japan
| | - Akihito Kawazoe
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shun Yamamoto
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Izuma Nakayama
- Gastroenterological Chemotherapy, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yukiya Narita
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University, Seoul, Republic of Korea
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, School of Medicine, International University of Health and Welfare, Otawara, Japan
| | - Takeshi Sano
- Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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Chevallay M, Brasset C, Marcelis J, Toso C, Jung M, Mönig SP. [Esophageal cancer: standards and innovations in multidisciplinary treatment]. Rev Med Suisse 2023; 19:1169-1174. [PMID: 37314255 DOI: 10.53738/revmed.2023.19.831.1169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Esophageal cancer is a severe disease that requires a combined therapeutic approach to improve the prognosis. Once the initial assessment is completed, the patient's case should be discussed in a multidisciplinary conference in a specialized center to decide on an appropriate therapeutic strategy taking into account the stage of the disease and the patient's general condition. Several advances in treatment, both from a surgical technique standpoint, with the advent of minimally invasive and robotic surgery, and from a medical perspective, with the use of immunotherapy under certain conditions, have dramatically improved mortality rates. In this article, we explore the standards and latest innovations in the multimodal treatment of esophageal cancer.
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Affiliation(s)
- Mickael Chevallay
- Service de chirurgie viscérale, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Camille Brasset
- Service de chirurgie viscérale, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Jordan Marcelis
- Service de chirurgie viscérale, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Christian Toso
- Service de chirurgie viscérale, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Minoa Jung
- Service de chirurgie viscérale, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Stefan Paul Mönig
- Service de chirurgie viscérale, Hôpitaux universitaires de Genève, 1211 Genève 14
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Sivanathan V, Utz C, Thomaidis T, Förster F, Stahl M, Lordick F, Ibach S, Kanzler S, Adler A, Mönig SP, Schimanski CC, Ignee A, Dietrich CF, Galle PR, Moehler M. Predictive Value of Preoperative Endoscopic Ultrasound (EUS) After Neoadjuvant Chemotherapy in Locally Advanced Esophagogastric Cancer - Data From a Randomized German Phase II Trial. Ultraschall Med 2022; 43:514-521. [PMID: 35226933 DOI: 10.1055/a-1593-4401] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The role of EUS before or after neoadjuvant chemotherapy (nCTX) in advanced esophagogastric cancer (EGC) is still unclear. The phase II NEOPECX trial evaluated perioperative chemotherapy with or without panitumumab in this setting. The aim of this sub-study was to investigate the prognostic value of EUS-guided preoperative staging before and after nCTX. MATERIALS AND METHODS Preoperative yuT/yuN stages by EUS were compared with histopathological ypT/ypN stages after curative resection. Reduction in T-stage from baseline to preoperative EUS was defined as downstaging (DS+) and compared to progression-free (PFS) and overall survival (OS) of patients without downstaging (DS-). In addition, preoperative EUS N-stages (positive N+ or negative N-) were correlated with clinical data. RESULTS The preoperative yuT-stage correlated with the ypT-stage in 48% of cases (sensitivity 48%, specificity 52%), while the preoperative yuN-stage correlated with the ypN-stage in 64% (sensitivity 76%, specificity 52%). Within DS+ patients who were downstaged by ≥ 2 T-categories, a trend towards improved OS was detected (median OS DS+: not reached (NR), median OS DS-: 38.5 months (M), p=0.21). Patients with yuN+ at preoperative EUS had a worse outcome than yuN- patients (median OS yuN-: NR, median OS yuN+: 38.5 M, p = 0.013). CONCLUSION The diagnostic accuracy of EUS to predict the response after nCTX in patients with advanced EGC is limited. In the current study the endosonographic detection of lymph node metastasis after nCTX indicates a poor prognosis. In the future, preoperative EUS with sectional imaging procedures may be used to tailor treatment for patients with advanced EGC.
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Affiliation(s)
- Visvakanth Sivanathan
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christoph Utz
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Thomas Thomaidis
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Friedrich Förster
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Michael Stahl
- Department of Medical Oncology, Hospitals Essen-Mitte Evangelische Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - Florian Lordick
- University Cancer Center Leipzig (UCCL), University of Leipzig Faculty of Medicine, Leipzig, Germany
| | - Stefan Ibach
- Biostatistik, WiSP Wissenschaftlicher Service Pharma GmbH, Langenfeld, Germany
| | - Stephan Kanzler
- Department of Internal Medicine II,, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany
| | - Andreas Adler
- Medical Department, Division of Hepatology and Gastroenterology, Charite University Hospital Berlin, Berlin, Germany
| | - Stefan Paul Mönig
- Department of Visceral Surgery, University Hospitals Geneva, Geneve, Switzerland
| | - Carl C Schimanski
- Department of Internal Medicine II, Hospital Darmstadt GmbH, Darmstadt, Germany
| | - Andre Ignee
- Department of Internal Medicine II, Caritas Hospital Bad Mergentheim, Bad Mergentheim, Germany
| | - Christoph F Dietrich
- Department of General and Internal Medicine, Hirslanden Clinic Beau Site, Salem and Permanence, Bern, Switzerland
| | - Peter R Galle
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Markus Moehler
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
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Jung MK, Chevallay M, Toso C, Mönig SP. Outcomes of oncologic robotic gastrectomy compared with open gastrectomy for early and locoregional advanced gastric cancer. Br J Surg 2022. [DOI: 10.1093/bjs/znac188.003] [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: 11/14/2022]
Abstract
Abstract
Objective
Minimally invasive gastrectomy for gastric cancer shows slower adoption in Western countries compared to Asia, probably due to lower incidence, advanced stages and a more frequently proximal localization, which requires a technically more challenging total gastrectomy.
Methods
We retrospectively reviewed a prospectively collected database. A total of 51 patients who underwent oncologic total gastrectomy or subtotal gastrectomy by robotic or open approach of stage pT1-T4a, pN0-3 were identified from June 2016 until June 2020. Nine patients were operated on robotically, and 42 patients by laparotomy. Perioperative outcomes, postoperative 30-day complications as well as pathologic results were compared.
Results
The age of the patients in the robotic group was comparable to that of the open group (64.7 ±9.2 versus 62.8 ±12.9, respectively, p = 0.685). Blood loss was significantly smaller with the robotic approach (185±180 mL versus 425±257 mL, p = 0.038). Pathologic tumor stage included stages pT1–pT4b in the open group, while only stages pT1–pT3 were operated by robotic approach. Fewer tumors were localized in the upper body in the robotic group (0, 0%) than in the open group (12, 28.6%). The length of the proximal margin was comparable in the two groups (104.29 ± 50.29 versus 86.88 ± 64.66, p = 0.516). The mean number of retrieved lymph nodes was comparable in the robotic group and the open group (42.89 ± 12.119 versus 43.22 ± 20.271, p = 0.963). The mean number of metastatic nodes was significantly lower in the robotic group (0.33 ± 0.707 versus 7.02 ± 14.313, p = 0.171). In regards to Lauren classification, diffuse-type cancers were significantly more frequent in the robotic group (3 (33.3%) versus 3 (8.6%), respectively, p = 0.040). Significantly fewer high-grade complications (Clavien/Dindo >3a) appeared in the robotic group (0 (0%) versus 2 (4.8%), p = 0.019). No anastomotic leakage and no death occurred in both groups.
Conclusion
The gold standard of oncologic gastrectomy, especially for advanced stages and bulky lymph nodes, is still the open approach. The minimally invasive approach for gastric cancer may be beneficial in regards to blood loss and postoperative complications but must show comparable pathohistological results in comparison to the open approach in regards to lymph node harvest and proximal tumor margins to be an acceptable alternative to the open approach.
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Affiliation(s)
- M K Jung
- Department of Surgery, University Hospital of Geneva , Geneva, Switzerland
| | - M Chevallay
- Department of Surgery, University Hospital of Geneva , Geneva, Switzerland
| | - C Toso
- Department of Surgery, University Hospital of Geneva , Geneva, Switzerland
| | - S P Mönig
- Department of Surgery, University Hospital of Geneva , Geneva, Switzerland
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Mann C, Wille K, Tagkalos E, Grimminger P, Berlth F, Mönig SP, Fetzner UK. [Modern Multimodal Concepts for Advanced and Metastatic Esophageal Cancer]. Ther Umsch 2022; 79:195-200. [PMID: 35440192 DOI: 10.1024/0040-5930/a001348] [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: 11/19/2022]
Abstract
Modern Multimodal Concepts for Advanced and Metastatic Esophageal Cancer Abstract. In case of locally advanced esophageal carcinoma, the clear recommendation for multimodal therapy has been established in the guidelines. This also applies to systemic therapy in the palliative, metastatic situation. Against the background of increasing experience with multimodal concepts and a parallel trend towards more and more personalized tumor therapy, therapy options that go beyond this are increasingly being used. The most recent chapter here is the successful use of antibodies and immune checkpoint inhibitors in the adjuvant, additive or palliative setting. Salvage concepts and the salvage operation are also used. These are efficient options to be able to react surgically from a situation of clinical remission and close observation in case of tumor recurrence. The limited radical surgical procedures with reconstruction according to "Merendino" and the "double tract procedure" with limited resection of the distal esophagus and proximal stomach via abdominal approach are options for high-risk patients or very elderly patients. They show great advantages with regard to the operational stress and - especially the "double tract procedure" - with regard to the quality of life. The oligometastatic situation is also the subject of ongoing studies. Under strict clinical observation, it may make sense not to exclude patients with very limited metastases from a curative concept. Numerous cases of long-term survival encourage this. In the palliative setting, in addition to classic chemotherapy and best supportive care, immunotherapy is also playing an increasingly important role, and here, too, a conversion to a curative concept is possible if the response is good. Palliative esophageal resections in the case of disseminated metastases, infiltration of vertebral bodies, aorta or trachea or main bronchi must be strictly avoided and must unfortunately be described as incurable.
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Affiliation(s)
- Carolina Mann
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Deutschland
| | - Kai Wille
- Universitätsklinik für Hämatologie, Onkologie, Hämostaseologie und Palliativmedizin, Johannes Wesling Klinikum Minden, Universitätsklinikum der Ruhr-Universität Bochum, Deutschland
| | - Evangelos Tagkalos
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Deutschland
| | - Peter Grimminger
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Deutschland
| | - Felix Berlth
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Deutschland
| | - Stefan Paul Mönig
- Department für Chirurgie, Chirurgie oberer Gastrointestinaltrakt, Universitätsklinikum Genf
| | - Ulrich Klaus Fetzner
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Deutschland.,Klinik für Allgemeinchirurgie, Viszeral-, Thorax-, Kinder- und Endokrine Chirurgie, Johannes Wesling Klinikum, Universitätsklinikum der Ruhr Universität Bochum, Minden, Deutschland
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Wille K, Mann C, Berlth F, Fetzner UK, Othmann K, Mönig SP. [Chemotherapy and Radio-Chemotherapy of Locally Advanced Esophageal Cancer]. Ther Umsch 2022; 79:189-194. [PMID: 35440193 DOI: 10.1024/0040-5930/a001347] [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: 11/19/2022]
Abstract
Chemotherapy and Radio-Chemotherapy of Locally Advanced Esophageal Cancer Abstract. Surgical resection alone of locally advanced esophageal carcinoma leads to long-term survival in only about 30% of cases. The multimodal strategy for locally advanced tumors, especially neoadjuvant radiochemotherapy and chemotherapy, has significantly improved the long-term prognosis. Multimodal therapy concepts have been developed which improve overall survival. Therapy planning must be performed pretherapeutically in an interdisciplinary tumor board, preferably at a high-volume center. For squamous cell carcinomas, neoadjuvant radio/chemotherapy followed by resection or definitive radio/chemotherapy are currently the therapies of choice. For adenocarcinomas, neoadjuvant radio/chemotherapy followed by resection or perioperative chemotherapy are considered equivalent therapeutic standards. After neoadjuvant radiochemotherapy, adjuvant immunotherapy is currently recommended in case of only incomplete histopathological response.
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Affiliation(s)
- Kai Wille
- Universitätsklinik für Hämatologie, Onkologie, Hämostaseologie und Palliativmedizin, Johannes Wesling Klinikum Minden, Universitätsklinikum der Ruhr-Universität Bochum, Minden, Deutschland
| | - Carolina Mann
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Deutschland
| | - Felix Berlth
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Deutschland
| | - Ulrich Klaus Fetzner
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Deutschland.,Klinik für Allgemeinchirurgie, Viszeral-, Thorax-, Kinder- und Endokrine Chirurgie, Johannes Wesling Klinikum, Universitätsklinikum der Ruhr Universität Bochum, Minden, Deutschland
| | - Katharina Othmann
- Klinik für Allgemeinchirurgie, Viszeral-, Thorax-, Kinder- und Endokrine Chirurgie, Johannes Wesling Klinikum, Universitätsklinikum der Ruhr Universität Bochum, Minden, Deutschland
| | - Stefan Paul Mönig
- Department für Chirurgie, Chirurgie oberer Gastrointestinaltrakt, Universitätsklinikum Genf
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7
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Müller PC, Kapp JR, Vetter D, Bonavina L, Brown W, Castro S, Cheong E, Darling GE, Egberts J, Ferri L, Gisbertz SS, Gockel I, Grimminger PP, Hofstetter WL, Hölscher AH, Low DE, Luyer M, Markar SR, Mönig SP, Moorthy K, Morse CR, Müller-Stich BP, Nafteux P, Nieponice A, Nieuwenhuijzen GAP, Nilsson M, Palanivelu C, Pattyn P, Pera M, Räsänen J, Ribeiro U, Rosman C, Schröder W, Sgromo B, van Berge Henegouwen MI, van Hillegersberg R, van Veer H, van Workum F, Watson DI, Wijnhoven BPL, Gutschow CA. Fit-for-Discharge Criteria after Esophagectomy: An International Expert Delphi Consensus. Dis Esophagus 2021; 34:5909885. [PMID: 32960264 DOI: 10.1093/dote/doaa101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/03/2020] [Accepted: 08/15/2020] [Indexed: 12/11/2022]
Abstract
There are no internationally recognized criteria available to determine preparedness for hospital discharge after esophagectomy. This study aims to achieve international consensus using Delphi methodology. The expert panel consisted of 40 esophageal surgeons spanning 16 countries and 4 continents. During a 3-round, web-based Delphi process, experts voted for discharge criteria using 5-point Likert scales. Data were analyzed using descriptive statistics. Consensus was reached if agreement was ≥75% in round 3. Consensus was achieved for the following basic criteria: nutritional requirements are met by oral intake of at least liquids with optional supplementary nutrition via jejunal feeding tube. The patient should have passed flatus and does not require oxygen during mobilization or at rest. Central venous catheters should be removed. Adequate analgesia at rest and during mobilization is achieved using both oral opioid and non-opioid analgesics. All vital signs should be normal unless abnormal preoperatively. Inflammatory parameters should be trending down and close to normal (leucocyte count ≤12G/l and C-reactive protein ≤80 mg/dl). This multinational Delphi survey represents the first expert-led process for consensus criteria to determine 'fit-for-discharge' status after esophagectomy. Results of this Delphi survey may be applied to clinical outcomes research as an objective measure of short-term recovery. Furthermore, standardized endpoints identified through this process may be used in clinical practice to guide decisions regarding patient discharge and may help to reduce the risk of premature discharge or prolonged admission.
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Affiliation(s)
- P C Müller
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - J R Kapp
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - D Vetter
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - L Bonavina
- IRCCS Policlinico San Donato, Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - W Brown
- Oesophago-Gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - S Castro
- Department of Surgery, Vall d'Hebron Hospital, Barcelona, Spain
| | - E Cheong
- Department of General Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - G E Darling
- Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - J Egberts
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - L Ferri
- Departments of Surgery and Oncology, Montreal General Hospital, McGill University, Montreal, Canada
| | - S S Gisbertz
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - I Gockel
- Department of Visceral, Thoracic, Transplant and Vascular surgery, University Hospital of Leipzig, Leipzig, Germany
| | - P P Grimminger
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - W L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, USA
| | - A H Hölscher
- Center for Oesophageal and Gastric Surgery, AGAPLESION Markus Krankenhaus, Frankfurt am Main, Germany
| | - D E Low
- Department of General, Thoracic and Vascular Surgery, Virginia Mason Medical Center, Seattle, USA
| | - M Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - S R Markar
- Imperial College Healthcare NHS Trust and Imperial College, London, UK
| | - S P Mönig
- Division of Visceral Surgery, Department of Surgery, University of Geneva, Hospitals and School of Medicine, Geneva, Switzerland
| | - K Moorthy
- Imperial College Healthcare NHS Trust and Imperial College, London, UK
| | - C R Morse
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, USA
| | - B P Müller-Stich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - P Nafteux
- Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
| | - A Nieponice
- Esophageal Institute, Hospital Universitario Fundacion Favaloro, Buenos Aires, Argentina
| | | | - M Nilsson
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - C Palanivelu
- Department of Surgical Gastroenterology, GEM Hospital & Research Centre, Coimbatore, India
| | - P Pattyn
- Department of Surgery, University Center Ghent, Ghent, Belgium
| | - M Pera
- Department of Surgery, Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Räsänen
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland
| | - U Ribeiro
- Department of Gastroenterology, Cancer Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - C Rosman
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - W Schröder
- Department of General, Visceral and Cancer Surgery, University of Cologne, Germany
| | - B Sgromo
- Department of Upper GI Surgery, Oxford University Hospitals, UK
| | | | - R van Hillegersberg
- Department of Surgical Oncology, University Medical Center Utrecht, The Netherlands
| | - H van Veer
- Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
| | - F van Workum
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - D I Watson
- Flinders University Department of Surgery, Flinders Medical Centre, Bedford Park, Australia
| | - B P L Wijnhoven
- Department of Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - C A Gutschow
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
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8
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Goetze TO, Piso P, Lorenzen S, Bankstahl US, Ostrzyzek M, Pauligk C, Habibzade T, Reim D, Bechstein WO, Königsrainer A, Mönig SP, Rau B, Schwarzbach M, Al-Batran SE. Preventive HIPEC in combination with perioperative FLOT versus FLOT alone for resectable diffuse type gastric and gastroesophageal junction type II/III adenocarcinoma: The phase III “PREVENT” trial of the AIO /CAOGI /ACO. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.tps4149] [Citation(s) in RCA: 1] [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: 11/20/2022] Open
Abstract
TPS4149 Background: The main reason for treatment failure after curative surgical resection of gastric cancer is intra-abdominal spread, with 40- 50% peritoneal seeding as primary localization of recurrence. Peritoneal relapse is seen in 60-70% of tumors of diffuse type, compared to only 20-30% of intestinal type. Hyperthermic IntraPEritoneal Chemoperfusion (HIPEC) is an increasingly used therapy method for patients with peritoneal metastases. The preventive use of HIPEC could represent an elegant approach for patients (pts) before macroscopic peritoneal seeding, since patients with operable disease are fit and may have potential risk of microscopic involvement, thus having a theoretical chance of cure with HIPEC even without the need for cytoreduction. No results from a PCRT from the Western hemisphere have yet been published. Methods: This is a multicenter, randomized, controlled, open-label study including a total of 200 pts with localized and locally advanced diffuse and mixed type (Laurens`s classification) adenocarcinoma of the stomach and Type II/III GEJ (i.e. ≥cT3 any N or any T N positive). All enrolled pts will have received 3-6 pre-operative cycles of biweekly FLOT (Docetaxel 50 mg/m²; Oxaliplatin 85 mg/m²; Leucovorin 200 mg/m²; 5-FU 2600 mg/m², q2wk). Pts will be randomized 1:1 to receive surgery only and postoperative FLOT (Arm A- Control arm) or surgery + intraoperative HIPEC (cisplatin 75mg/m2 solution administered at a temperature of 42°C for 90 minutes) and postoperative FLOT (Arm B- experimental arm). Surgery is carried out as gastrectomy or transhiatal extended gastrectomy. Primary endpoint is PFS/DFS, major secondary endpoints are OS, R0 resection rate, perioperative morbidity/mortality including VAS pain score and quality of life as assessed by EORTC QLQ C30 questionnaire. The trial starts with a safety run-in phase. After 20 patients had curatively intended resection in Arm B, an interim safety analysis is performed assessing feasibility, safety, and tolerability in Arm B. First patient was randomized on 18JAN2021. Currently one patient is recruited. EudraCT: 2017-003832-35; ClinicalTrials.gov ID: NCT04447352. Clinical trial information: NCT04447352.
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Affiliation(s)
- Thorsten Oliver Goetze
- University Cancer Center Frankfurt, Institut für Klinisch-Onkologische Forschung and Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Pompiliu Piso
- Department for General and Visceral Surgery, Hospital Barmherzige Brueder, University of Regensburg, Regensburg, Germany
| | - Sylvie Lorenzen
- Third Department of Internal Medicine (Hematology/Medical Oncology), Klinikum Rechts der Isar, Technische Universitaet Muenchen, Muenchen, Germany
| | - Ulli Simone Bankstahl
- University Cancer Center Frankfurt, Institut für Klinisch-Onkologische Forschung am Krankenhaus Nordwest, Frankfurt, Germany
| | - Marcin Ostrzyzek
- Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Claudia Pauligk
- Institute of Clinical Cancer Research (IKF) GmbH at Krankenhaus Nordwest, Frankfurt, Germany
| | - Timursah Habibzade
- Institute of Clinical Cancer Research, Krankenhaus Nordwest, UCT University Cancer Center, Frankfurt Am Main, Germany
| | - Daniel Reim
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Wolf Otto Bechstein
- Department of General and Visceral Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Alfred Königsrainer
- Department of General-, Visceral Surgery and Transplantation, University Hospital Tuebingen, Tuebingen, Germany
| | | | - Beate Rau
- Charite Campus Mitte University of Berlin, Berlin, Germany
| | - Matthias Schwarzbach
- Klinikum Frankfurt-Höchst, Department of General, Visceral, Vascular and Thoracic Surgery, Frankfurt, Germany
| | - Salah-Eddin Al-Batran
- University Cancer Center Frankfurt, Institut für Klinisch-Onkologische Forschung and Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
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9
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Mönig SP, Chevallay M, Niclauss N, Toso C, Frossard JL, Koessler T, Jung MK. [Esophageal and esophago-gastric junction cancer : management and multimodal treatment]. Rev Med Suisse 2020; 16:1292-1299. [PMID: 32608586] [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: 06/11/2023]
Abstract
Esophageal cancer remains an oncological burden with a low survival rate. Multidisciplinary management is essential to offer an adjusted treatment to the patient general condition and the tumor stage. New minimally invasive surgical treatments help to reduce the surgical trauma and improve post-operative patient recovery. Oncological treatments have also evolved and definitive treatment by radio-chemotherapy can be proposed in specific cases.
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10
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Bonino MA, Bartoletti S, Niclauss N, Pataky Z, Toso C, Mönig SP, Hagen M, Jung MK. [Not Available]. Rev Med Suisse 2020; 16:181-183. [PMID: 31995295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | | | | | - Zoltan Pataky
- Service d'endocrinologie, diabétologie, nutrition et éducation du patient, HUG, 1211 Genève 14
| | | | | | - Monika Hagen
- Service de chirurgie viscérale, HUG, 1211 Genève 14
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11
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Mönig SP, Bonino MA. Delay in initiation adjuvant S-1 monotherapy for gastric cancer: important prognostic factor. Transl Gastroenterol Hepatol 2019; 4:61. [DOI: 10.21037/tgh.2019.07.03] [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: 06/19/2019] [Accepted: 07/25/2019] [Indexed: 11/06/2022] Open
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12
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Abstract
The therapeutic approach to patients with oligometastatic gastric cancer and esophageal cancer is currently undergoing a shift towards a more aggressive therapy including surgical resection. In the current German S3 guidelines surgical treatment of metastatic disease is not recommended; however, nowadays interdisciplinary tumor boards have to evaluate such patients increasingly more often. On an individual basis a radical surgical resection of the primary tumor and the metastases is considered and performed in patients who respond well to multimodal chemotherapy concepts. In this review article the currently available data from the literature are discussed and a foundation for individually extended surgical approaches is presented. Together with the currently available results of the FLOT 3 study and the mostly retrospective studies, it seems to be possible to identify patients who would profit from such an aggressive treatment. In the future randomized prospective studies, such as the RENAISSANCE/FLOT 5 study and the GASTRIPEC study will have to evaluate whether an aggressive surgical therapy within multimodal therapy concepts of metastatic gastric and esophageal carcinomas is warranted.
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Affiliation(s)
- T Schmidt
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69117, Heidelberg, Deutschland.
| | - S P Mönig
- Department of Surgery, Upper-GI-Surgery, Geneva University Hospitals, Geneva, Schweiz
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13
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Abstract
In the current German S3 guidelines surgical treatment is not recommended for metastatic gastric cancer or metastatic adenocarcinoma of the esophagogastric junction; however, in routine practice the indications can be extended so that there may be occasions in which radical surgical intervention for specific individuals may be appropriate as part of a multimodal therapy with curative intent. This article presents the scientific rationale of such an approach based on the available literature considering modern, multimodal therapy concepts including criteria to be met for radical surgery. Currently only retrospective trials and limited current meta-analysis data are available for justifying surgical treatment for metastatic adenocarcinoma. The recently published initial results of the FLOT-3 study identified a patient subgroup that benefits from a resection even though metastasis has occurred. Whether surgical therapy will become an integral part of the treatment of limited metastatic adenocarcinoma of the stomach and esophagus in the future, has to be demonstrated by large prospective randomized studies, such as the RENAISSANCE/FLOT-5 study.
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Affiliation(s)
- S P Mönig
- Klinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland. .,Service de Chirurgie viscéral, Hôpitaux Universitaires de Genève, Rue Gabrielle Perret-Gentil 4, CH-1211, Genève, Switzerland.
| | - L M Schiffmann
- Klinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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14
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Niclauss N, Chevallay M, Frossard JL, Mönig SP. [Surgical strategy for early stage carcinoma of the esophagus]. Chirurg 2018; 89:339-346. [PMID: 29392342 DOI: 10.1007/s00104-018-0589-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Early stage carcinomas of the esophagus are histologically differentiated into adenocarcinomas and squamous cell carcinomas and subdivided into mucosal (m1-3) and submucosal (sm1-3) carcinomas depending on the infiltration depth. While the prevalence of lymph node metastases in mucosal carcinomas is very low, the probability of lymph node metastases increases from submucosal infiltration with increasing depth. According to the current German S3 guidelines endoscopic resection is the recommended treatment strategy for mucosal adenocarcinoma without histological risk factors (lymphatic invasion [L1], venous invasion [V1], poorly differentiated [>G2], microscopic residual disease [R1] at the deep resection margin). For superficial submucosal infiltration (sm1) without histological risk factors endoscopic resection can also be carried out, whereby in this case the guidelines make a stronger recommendation for esophagectomy. For squamous cell carcinoma endoscopic resection is indicated for an infiltration depth up to middle layer mucosal carcinoma (m2) without histological risk factors. Outside of these criteria an esophageal resection should always be carried out. The surgical gold standard is a subtotal abdominothoracic esophagectomy with two-field lymphadenectomy. Alternative procedures are total esophagectomy in proximal esophageal carcinoma and transhiatal extended gastrectomy for carcinoma of the cardia. Limited proximal or distal esophageal resections can be performed in proximal or distal mucosal carcinoma without the possibility of endoscopic resection; however, partial resections are not superior in terms of functional results and are not oncologically equivalent due to limited lymphadenectomy. Minimally invasive procedures show good oncological 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.
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Affiliation(s)
- N Niclauss
- Service de chirurgie viscérale, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Genf, Schweiz
| | - M Chevallay
- Service de chirurgie viscérale, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Genf, Schweiz
| | - J L Frossard
- Service de gastroentérologie et hépatologie, Hôpitaux Universitaires de Genève, Genf, Schweiz
| | - S P Mönig
- Service de chirurgie viscérale, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Genf, Schweiz.
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15
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Abstract
HISTORY AND FINDINGS UPON ADMISSION A 50-year-old man presented at the emergency unit with abdominal pain in the right lower quadrant and dysuria. He described an increase in pain during micturition. EXAMINATIONS After multiple examinations (CT-scan, MR-scan, ileocolonoscopy) were performed to no avail, a toothpick was detected in the terminal ileum during an ultrasound scan of the small intestine. Prompted elevation of intra-abdominal pressure led to migration of the radiolucent sharp foreign body into the wall of the urinary bladder, inducing pain. TREATMENT Median laparotomy revealed a two-sided perforation of the terminal ileum with ileosigmoidal fistula, which was induced by an ingested toothpick. The patient underwent en-bloc resection of the infectious tumor by segmental ileal resection and sigma resection. Anastomoses were performed as hand-sewn end-to-end ileoileostomy and end-to-end stapled colorectal anastomosis, respectively. CONCLUSION Ingested foreign bodies and perforation of the gastrointestinal tract by foreign bodies are rare events but may cause serious gut injuries. The ingestion of foreign bodies should be kept in mind as an important differential diagnosis in patients with acute abdomen or chronic abdominal pain of unknown origin, especially in children. Abdominal ultrasound can be a useful diagnostic tool in identifying ingested foreign bodies.
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Affiliation(s)
- Philipp Kasper
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln
| | - Fabian Kütting
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln
| | - Hans Anton Schlößer
- Klinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinikum Köln
| | | | - Tobias Goeser
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln
| | - Natalie Jaspers
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln
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16
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Favi F, Bollschweiler E, Berlth F, Plum P, Hescheler DA, Alakus H, Semrau R, Celik E, Mönig SP, Drebber U, Hölscher AH. Neoadjuvant chemotherapy or chemoradiation for patients with advanced adenocarcinoma of the oesophagus? A propensity score-matched study. Eur J Surg Oncol 2017; 43:1572-1580. [PMID: 28666624 DOI: 10.1016/j.ejso.2017.06.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 01/14/2017] [Revised: 04/10/2017] [Accepted: 06/06/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Multimodal therapies are the standard of care for advanced adenocarcinomas of the oesophagus and gastro-oesophageal junction (AEG Types I and II). Only three randomised trials have compared preoperative chemotherapy with and without radiation. The results showed a small benefit for combined chemoradiation. In the meantime, newer therapy protocols are available. AIM In a propensity-score matched study, we analysed patients with locally advanced AEG type I or II, treated with chemotherapy (FLOT-protocol) or chemoradiation (CROSS-protocol), followed by oesophagectomy, in a single high-volume centre. PATIENTS AND METHODS Between 2011 and 2015, 137 patients with advanced (cT3NxcM0) adenocarcinoma received pre-operative therapy; 70% had chemoradiation (CROSS-protocol) and 30% had chemotherapy (FLOT-protocol). After propensity-score matching, 40 patients from the CROSS-group were selected for analysis. Postoperative histopathological response and prognosis were analysed. RESULTS The two groups were comparable according to the matching criteria age, gender, tumour location, and year of surgery. R0-resection was achieved in 97% of patients in the CROSS-group and 85% of the FLOT-group (p = 0.049). Major response of the primary tumour was evident more often in the CROSS-group (17/40 pts. 43%) versus FLOT-group (11/40 pts. 27%) as well no lymph node metastasis (ypN0 = 68% versus ypN0 = 40%) (p = 0.014). Prognosis were not significantly different between the two groups. In multivariate analysis, only ypN-category was an independent prognostic factor. CONCLUSION Compared to FLOT-chemotherapy, neoadjuvant chemoradiotherapy with the CROSS-protocol in locally advanced adenocarcinoma AEG types I and II resulted in better response by the primary tumour and less lymph node metastasis but without superior survival.
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Affiliation(s)
- F Favi
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - E Bollschweiler
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany.
| | - F Berlth
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - P Plum
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - D A Hescheler
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - H Alakus
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - R Semrau
- Department of Radiation Oncology, University of Cologne, Cologne, Germany
| | - E Celik
- Department of Radiation Oncology, University of Cologne, Cologne, Germany
| | - S P Mönig
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany; Service de Chirurgie Viscéral, Hôpitaux Universitaires de Genève, Switzerland
| | - U Drebber
- Institute of Pathology, University of Cologne, Cologne, Germany
| | - A H Hölscher
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany; Department of Surgery, AGAPLESION Markus Krankenhaus, Frankfurt, Germany
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17
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Berlth F, Chon SH, Chevallay M, Jung MK, Mönig SP. Preoperative staging of nodal status in gastric cancer. Transl Gastroenterol Hepatol 2017; 2:8. [PMID: 28217758 DOI: 10.21037/tgh.2017.01.08] [Citation(s) in RCA: 9] [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: 09/26/2016] [Accepted: 01/04/2017] [Indexed: 12/21/2022] Open
Abstract
An accurate preoperative staging of nodal status is crucial in gastric cancer, because it has a great impact on prognosis and therapeutic decision-making. Different staging methods have been evaluated for gastric cancer in order to predict nodal involvement. So far, no technique could meet the necessary requirements, which include a high detection rate of infiltrated lymph nodes and a low frequency of false-positive results. This article summarizes different staging methods used to assess lymph node status in patients with gastric cancer, evaluates the evidence, and proposes to establish new methods.
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Affiliation(s)
- Felix Berlth
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Seung-Hun Chon
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Mickael Chevallay
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Minoa Karin Jung
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Stefan Paul Mönig
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland
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18
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Abstract
Minimally invasive operative procedures are increasingly being used for treating tumors of the upper gastrointestinal tract. While minimally invasive surgery (MIS) has become established as a standard procedure for benign tumors and gastrointestinal stromal tumors (GIST) based on current studies, the significance of MIS in the field of gastric cancer is the topic of heated debate. Until now the majority of studies and meta-analyses on gastric cancer have come from Asia and these indicate the advantages of MIS in terms of intraoperative blood loss, minor surgical complications and swifter convalescence although without any benefits in terms of long-term oncological results and quality of life. Unlike in Germany, gastric cancer in Asia with its unchanged high incidence rate, 50 % frequency of early carcinoma and predominantly distal tumor localization is treated at high-volume centres. Due to the proven marginal advantages of MIS over open resection described in the published studies no general recommendation for laparoscopic surgery of gastric cancer can currently be given.
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Affiliation(s)
- S P Mönig
- Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland,
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19
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Wolfgarten E, Mönig SP, Fetzner UK, Schröder W, Bollschweiler E. [Experience with an interdisciplinary surgical handbook for medical students]. Zentralbl Chir 2012; 137:180-6. [PMID: 22287089 DOI: 10.1055/s-0031-1283810] [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: 10/14/2022]
Abstract
BACKGROUND There is a lack of well-trained surgeons in Germany. The medical students get their last contact to a surgical discipline in the final year of their medical education. The student's decision for a medical discipline is surely influenced by bad experiences during the last practical training in surgery. The aim of our project was to give the medical students an engaged and structured understanding of surgery with the aid of a logbook. It was tested in a pilot phase and should increase the number of final year students and their interest in surgery in the long-term. METHODS From 5 / 2009 the structure of the surgical part of the final year was worked over by the Clinics for General, Visceral und Tumour Surgery, Vascular Surgery, Heart and Thoracic Surgery and Trauma Surgery. A logbook was developed which includes the rotation through the 4 different surgical departments, lists the targets of study and the practical exercises in obligatory and optional schedules, defines one patient care per rotation and introduces a mentoring system. The logbook is clearly represented and the required signatures of the senior doctors are minimized. After the surgical term the students filled out a questionnaire and were interviewed about the pros and cons of the logbook. RESULTS In December 2009 the new logbook was distributed for the first time. Until now 113 final year students have used it. The first evaluation of 45 students showed a positive rating of the clinical organization and structure of the clinic, the list of the learning targets and the practical skills. The implementation of the mentoring system and the required signatures were still incomplete. The final year students wished for more training time for the doctors. The positive response of the final year students results in an increasing number of final year students chosing a career in surgery. CONCLUSION The new logbook for the surgical part of the final year at the University of Cologne helps the students with the daily routine of the surgical departments, gives a review of the learning targets and emphasizes a good surgical training.
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Affiliation(s)
- E Wolfgarten
- Uniklinik Köln, Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Köln, Deutschland.
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20
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Vallböhmer D, Hölscher AH, Schneider PM, Schmidt M, Dietlein M, Bollschweiler E, Baldus S, Alakus H, Brabender J, Metzger R, Mönig SP. [18F]-fluorodeoxyglucose-positron emission tomography for the assessment of histopathologic response and prognosis after completion of neoadjuvant chemotherapy in gastric cancer. J Surg Oncol 2010; 102:135-40. [PMID: 20648583 DOI: 10.1002/jso.21592] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES Neoadjuvant chemotherapy is applied to improve the prognosis of patients with advanced gastric cancer. However, only a major histopathological response will provide a benefit. Recent studies suggest that [(18)F]-fluorodeoxyglucose-positron-emission-tomography (FDG-PET) correlates with response and survival in patients with gastroesophageal adenocarcinomas undergoing neoadjuvant chemotherapy. We evaluated the potential of FDG-PET for the assessment of response and prognosis in the multimodality treatment of gastric cancer. METHODS Study patients were recruited from a prospective observation trial. Forty two patients with advanced gastric cancer received neoadjuvant chemotherapy and subsequently 40 patients underwent standardized gastrectomy (2 patients with tumor progression had therapy limited to palliative chemotherapy without surgery). Histomorphologic regression was defined as major response when resected specimens contained <10% vital tumor cells. FDG-PET was performed before and 2 weeks after the end of neoadjuvant chemotherapy with assessment of the intratumoral FDG-uptake [pre-treatment standardized uptake value (SUV1); post-treatment SUV (SUV2); percentage change (SUVDelta%)]. RESULTS Histomorphological tumor regression was confirmed as a prognostic factor (P = 0.039). No significant correlations between SUV1, SUV2, or SUVDelta% and response or prognosis were found. CONCLUSION FDG-PET seems not to be an imaging system that effectively characterizes major/minor response and survival in patients with gastric cancer following multimodality treatment.
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Affiliation(s)
- D Vallböhmer
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
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21
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Prenzel KL, Hölscher AH, Vallböhmer D, Drebber U, Gutschow CA, Mönig SP, Stippel DL. Lymph node size and metastatic infiltration in adenocarcinoma of the pancreatic head. Eur J Surg Oncol 2010; 36:993-6. [PMID: 20594789 DOI: 10.1016/j.ejso.2010.06.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 05/02/2010] [Accepted: 06/07/2010] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Preoperative lymph node staging of pancreatic cancer by CT relies on the premise that malignant lymph nodes are larger than benign nodes. In imaging procedures lymph nodes >1 cm in size are regarded as metastatic nodes. The extend of lymphadenectomy and potential application of neoadjuvant therapy regimens could be dependent on this evaluation. PATIENTS AND METHODS In a morphometric study regional lymph nodes from 52 patients with pancreatic cancer were analyzed. The lymph nodes were counted, the largest diameter of each node was measured, and each node was analyzed for metastatic involvement by histopathological examination. The frequency of metastatic involvement was calculated and correlated with lymph node size. RESULTS A total of 636 lymph nodes were present in the 52 specimens examined for this study (12.2 lymph nodes per patient). Eleven patients had a pN0 status, whereas 41 patients had lymph nodes that were positive for cancer. Five-hundred-twenty (82%) lymph nodes were tumor-free, while 116 (18%) showed metastatic involvement on histopathologic examination. The mean (±SD) diameter of the nonmetastatic nodes was 4.3 mm, whereas infiltrated nodes had a diameter of 5.7 mm (p = 0.001). Seventy-eight (67%) of the infiltrated lymph nodes and 433 (83%) of the nonmetastatic nodes were ≤5 mm in diameter. Of 11 pN0 patients, 5 (45%) patients had at least one lymph node ≥10 mm, in contrast only 12 (29%) out of 41 pN1 patients had one lymph node ≥10 mm. CONCLUSION Lymph node size is not a reliable parameter for the evaluation of metastatic involvement in patients with pancreatic cancer.
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Affiliation(s)
- K L Prenzel
- Department of General, Visceral and Cancer Surgery, University of Cologne, Germany.
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Affiliation(s)
- Stefan Paul Mönig
- Department of General, Visceral and Cancer Surgery, University of Cologne, Joseph-Stelzmann-Strasse 9, 50931, Cologne, Germany.
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Grundmann RT, Hölscher AH, Bembenek A, Bollschweiler E, Drognitz O, Feuerbach S, Gastinger I, Hermanek P, Hopt UT, Hünerbein M, Illerhaus G, Junginger T, Kraus M, Meining A, Merkel S, Meyer HJ, Mönig SP, Piso P, Roder J, Rödel C, Tannapfel A, Wittekind C, Woeste G. [Diagnosis of and therapy for gastric cancer--work-flow]. Zentralbl Chir 2009; 134:362-74. [PMID: 19688686 DOI: 10.1055/s-0029-1224534] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM This review comments on the diagnosis and treatment of gastric cancer in the classical meaning--excluding adenocarcinoma of the -oesophagogastric junction. Algorithms of diagnosis and care with respect to tumour stage are presented. PREOPERATIVE DIAGNOSIS: Besides oesophagogastroduodenoscopy, endoscopic ultrasonography is necessary for the accurate diagnosis of T categories and as a selection criterion for neoadjuvant chemotherapy. Computed tomography is recommended for preoperative evaluation of tumours > T1, laparoscopy has become an effective stag-ing tool in T3 and T4 tumours avoiding unnecessary laparotomies and improving the detection of small -liver and peritoneal metastases. TREATMENT Endoscopic mucosal resection and submucosal dissection are indicated in superficial cancer confined to the mucosa with special characteristics (T1 a / no ulcer / G1, 2 / Laurén intestinal / L0 / V0 / tumour size < 2 cm). In all other cases total gastrectomy or distal subtotal gastric resection are indicated, the latter in cases of tumours located in the distal two-thirds of the stomach. Standard lymphadenectomy (LAD) is the D2 LAD without distal pancreatectomy and splenectomy. The Roux-en-Y oesophagojejunostomy is still the preferred type of reconstruction. An additional pouch reconstruction should be considered in -patients with favourable prognosis, this also -applies for the preservation of the duodenal passage by jejunum interposition. Extended organ resections are only indicated in cases where a R0-resection is possible. Hepatic resection for metachronous or synchronous liver metastases is rarely advised since 50 % of patients with liver metastases show concomitant peritoneal dissemination of the disease. DISCUSSION AND CONCLUSIONS Undergoing gastrectomy at a high-volume centre is associated with lower in-hospital mortality and a better prognosis, however, clear thresholds for case load cannot be given. Perioperative chemotherapy and postoperative chemoradiotherapy are based on the MAGIC and MacDonald trials. Perioperative chemotherapy should be performed in patients with T3 and T4 tumours with the aim to increase the likelihood of curative R0-resection by downsizing the tumour. Adjuvant postoperative chemotherapy cannot be recommended since its benefit has so far not been proven in randomised trials. In selected patients with incomplete lymph-node dissection and questionable R0-resection postoperative chemoradiotherapy may be debated.
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Affiliation(s)
- R T Grundmann
- Kreiskliniken Altötting-Burghausen, Burghausen, Germany.
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Alakus H, Warnecke-Eberz U, Bollschweiler E, Mönig SP, Vallböhmer D, Brabender J, Drebber U, Baldus SE, Riemann K, Siffert W, Hölscher AH, Metzger R. GNAS1 T393C polymorphism is associated with histopathological response to neoadjuvant radiochemotherapy in esophageal cancer. Pharmacogenomics J 2009; 9:202-7. [PMID: 19274060 DOI: 10.1038/tpj.2009.5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Recent studies have shown an association between the GNAS1 T393C polymorphism and clinical outcome for various solid tumors. In this study, we genotyped 51 patients from an observational trial on cisplatin/5-FU-based neoadjuvant radiochemotherapy of locally advanced esophageal cancer (cT2-4, Nx, M0) and genotyping was correlated with histomorphological tumor regression. The C-allele frequency in esophageal cancer patients was 0.49. Pearson's chi(2)-test showed a significant (P<0.05) association between tumor regression grades and T393C genotypes. Overall, 63% of the patients in the T-allele group (TT+CT) were minor responders with more than 10% residual vital tumor cells in resection specimens, whereas T(-) genotypes (CC) showed a major histopathological response with less than 10% residual vital tumor cells in 80%. The results support the role of the T393C polymorphism as a predictive molecular marker for tumor response to cisplatin/5-FU-based radiochemotherapy in esophageal cancer.
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Affiliation(s)
- H Alakus
- Department of General, Visceral and Cancer Surgery, Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
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Hölscher AH, Vallböhmer D, Bollschweiler E, Mönig SP. [Actual achievements in the therapy of esophagogastric carcinomas]. MMW Fortschr Med 2009; 151:29-31. [PMID: 19391408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- A H Hölscher
- Klinik und Poliklinik für Algemein-, Viszeral- und Tumorchirurgie der Universität zu Köln, Köln.
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Alakus H, Grass G, Hennecken JK, Bollschweiler E, Schulte C, Drebber U, Baldus SE, Metzger R, Hölscher AH, Mönig SP. Clinicopathological significance of MMP-2 and its specific inhibitor TIMP-2 in gastric cancer. Histol Histopathol 2008; 23:917-23. [PMID: 18498066 DOI: 10.14670/hh-23.917] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Matrix metalloproteinases (MMPs) can degrade type IV collagen of extracellular matrices and basal membranes and thus play a key role in the migration of malignant cells. In vivo, MMPs are inhibited by tissue inhibitors of metalloproteinases (TIMPs). Since in a previous study we showed that the expression of MMP-2 correlates with clinicopathological parameters in gastric cancer, we have now investigated a possible correlation of MMP-2 and TIMP-2 expression with survival in gastric cancer, as well as the possible association of TIMP-2 with clinicopathological parameters. Tissue samples were obtained from 116 gastric cancer patients who underwent gastrectomy with extended lymphadenectomy. MMP-2 and TIMP-2 expression was analysed using immunohistochemical staining and was graded semiquantitatively (score 0 - 3). High epithelial MMP-2 immunoreactivity was significantly associated with tumor stage and poor survival using the Kaplan-Meier log-rank statistical method (log-rank statistics). However, using Cox regression analysis, high epithelial MMP-2 immunoreactivity was not an independent prognostic factor. TIMP-2 showed no association with survival in gastric cancer, but the intensity of TIMP-2 staining in tumor cells correlated significantly with tumor differentiation based on the WHO and Lauren and Ming classifications, as well as with presence of distant metastasis. Our results show that high epithelial MMP-2 expression in gastric cancer is associated with poor survival, although it is not an independent prognostic factor, and that aggressive forms of gastric cancer are associated with low TIMP-2 expression.
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Affiliation(s)
- H Alakus
- Department of Visceral- and Vascular Surgery, University of Cologne, Cologne, Germany
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Abstract
Ulcer surgery today concentrates on the complications of chronic ulcer disease, especially ulcer perforation and endoscopically uncontrollable ulcer bleeding. In this case the laparoscopic or open closure of the gastroduodenal defect or local hemostasis of the bleeding ulcer by laparotomy are the main aims of surgery. Elective operations due to recurrent gastric or duodenal ulcers have become rare. An indication for gastric ulcer resistant to conservative therapy could be persisting suspicion of malignancy whereas in duodenal ulcer gastric outlet obstruction represents a reason for surgery. If these indications are confirmed the classic procedures of gastric resection like Billroth I and Billroth II are performed whereas vagotomy is no longer used. Altogether ulcer surgery has become very safe although it is practiced quite rarely.
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Affiliation(s)
- A H Hölscher
- Klinik und Poliklinik für Visceral- und Gefässchirurgie der Universität, Köln, Kerpener Strasse 62, 50937 Köln.
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Baldus SE, Mönig SP, Zirbes TK, Thakran J, Köthe D, Köppel M, Hanisch FG, Thiele J, Schneider PM, Hölscher AH, Dienes HP. Lewis(y) antigen (CD174) and apoptosis in gastric and colorectal carcinomas: correlations with clinical and prognostic parameters. Histol Histopathol 2006; 21:503-10. [PMID: 16493580 DOI: 10.14670/hh-21.503] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Lewis(y) (Le(y)), also designated CD174, represents a carbohydrate blood group antigen which is strongly expressed in neoplastic gastrointestinal tissues. Previous reports indicated an association between Le(y) expression and apoptosis. Therefore, we tried to elucidate its clinicopathological relevance in a series of 160 gastric and 215 colorectal carcinomas by immunohistochemical detection of Le(y) and visualization of apoptotic cells applying the in-situ-end labelling (ISEL) method, followed by semiquantitative scoring of the specimens. In both gastric as well as colorectal carcinomas, between 40 and 50% of the cases were Le(y) reactive. Signet-ring cell carcinomas of the stomach exhibited a significantly stronger Le(y) expression compared to other tumor types. In colorectal cancers, Le(y) was associated with increased tumor staging, showing the strongest positivity in stage IV. Further correlations with clinicopathological variables or prognosis were not observed. On the other hand, the amount of apoptotic cells was significantly reduced in mucinous adenocarcinomas of the colorectum compared to non-mucinous carcinomas. Scoring of apoptotic cells did not result in any other clinicopathologically relevant correlations. In addition, a significant association between Le(y) antigen expression and apoptosis score could not be established. Therefore, the hypothesis of a functional relationship between these two aspects of gastrointestinal tumor biology is not confirmed by our data.
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Affiliation(s)
- S E Baldus
- Intitute of Pathology, University of Düesseldorf, Düesseldorf, Germany.
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Hensler K, Waschulzik T, Mönig SP, Maruyama K, Hölscher AH, Bollschweiler E. Quality-assured Efficient Engineering of Feedforward Neural Networks (QUEEN) -- pretherapeutic estimation of lymph node status in patients with gastric carcinoma. Methods Inf Med 2006. [PMID: 16400373 DOI: 10.1055/s-0038-1634021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Lymph node metastasis (LNM) is an important prognostic indicator in patients with gastric carcinoma. However, the methods that have been established for preoperative diagnosis of LNM show insufficient accuracy. METHODS This study describes the use of the Quality Assured Efficient Engineering of Feedforward Neural Networks with Supervised Learning (QUEEN) technique to attempt optimization of the preoperative diagnosis of lymph node metastasis in patients with gastric carcinoma. The results were compared with the Maruyama Diagnostic System (MDS) for preoperative prediction of LNM, established at the National Cancer Center in Tokyo. RESULTS QUEEN is able to extract predictive variables from a case-based database. The combination of a development method, a special type of neural network and the corresponding encoding yielded an accuracy of 72.73%, which is notably higher than that of the MDS. Our system produced a nearly ten per cent higher sensitivity and around eighteen per cent higher specificity than MDS. CONCLUSION Our results show that QUEEN is a reasonable method for the development of ANNs. We used the QUEEN system for prediction of LNM in gastric cancer. This system may allow more meaningful preoperative planning by gastric surgeons.
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Affiliation(s)
- K Hensler
- Department of Visceral and Vascular Surgery, University of Cologne, Joseph-Stelzmann-Str. 9, 50931 Köln, Germany
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Hensler K, Waschulzik T, Mönig SP, Maruyama K, Hölscher AH, Bollschweiler E. Quality-assured Efficient Engineering of Feedforward Neural Networks (QUEEN) -- pretherapeutic estimation of lymph node status in patients with gastric carcinoma. Methods Inf Med 2005; 44:647-54. [PMID: 16400373] [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: 05/06/2023]
Abstract
OBJECTIVES Lymph node metastasis (LNM) is an important prognostic indicator in patients with gastric carcinoma. However, the methods that have been established for preoperative diagnosis of LNM show insufficient accuracy. METHODS This study describes the use of the Quality Assured Efficient Engineering of Feedforward Neural Networks with Supervised Learning (QUEEN) technique to attempt optimization of the preoperative diagnosis of lymph node metastasis in patients with gastric carcinoma. The results were compared with the Maruyama Diagnostic System (MDS) for preoperative prediction of LNM, established at the National Cancer Center in Tokyo. RESULTS QUEEN is able to extract predictive variables from a case-based database. The combination of a development method, a special type of neural network and the corresponding encoding yielded an accuracy of 72.73%, which is notably higher than that of the MDS. Our system produced a nearly ten per cent higher sensitivity and around eighteen per cent higher specificity than MDS. CONCLUSION Our results show that QUEEN is a reasonable method for the development of ANNs. We used the QUEEN system for prediction of LNM in gastric cancer. This system may allow more meaningful preoperative planning by gastric surgeons.
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Affiliation(s)
- K Hensler
- Department of Visceral and Vascular Surgery, University of Cologne, Joseph-Stelzmann-Str. 9, 50931 Köln, Germany
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Baldus SE, Mönig SP, Schröder W, Metzger R, Lang S, Zirbes TK, Thiele J, Müller RP, Dienes HP, Hölscher AH, Schneider PM. Regression von �sophaguskarzinomen nach neoadjuvanter Radiochemotherapie. Pathologe 2004; 25:421-7. [PMID: 15168076 DOI: 10.1007/s00292-004-0697-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Following surgical resection locally advanced oesophageal carcinomas exhibit a bad prognosis and therefore neoadjuvant therapeutic strategies were developed. Because success of therapy is associated with the extent of tumor regression in this context, the introduction of objective histopathological criteria seems to be very important. This study included 67 patients with oesophageal carcinomas (cT2-cT4 cNx cM0) that were treated with a cisplatin- and 5-fluorouracil-containing simultaneous radiochemotherapy. In 43 patients squamous cell, in 24 cases adenocarcinomas were diagnosed. After completion of therapy, a surgical resection and a histopathological examination of the tissue specimens were performed. The extent of tumor regression was histologically evaluated and therapy-induced alterations were graded semiquantitatively. Thereby, a significantly favorable prognosis was observed in the group of patients that showed a regression of carcinomas of 90% or more. Additionally, the extent of a resorptive-histiocytic reaction, giant cells and lymphocytic infiltrates correlated with the grade of regression. These results underline the importance of an exact examination and histomorphological evaluation of the response for the assessment of survival probability after neoadjuvant radiochemotherapy of oesophageal carcinomas.
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Affiliation(s)
- S E Baldus
- Institut für Pathologie, Universität zu Köln, Joseph-Stelzmann-Strasse 9, 50931 Köln.
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Lübke T, Mönig SP, Schneider PM, Hölscher AH, Bollschweiler E. [Does Charlson-comorbidity index correlate with short-term outcome in patients with gastric cancer?]. Zentralbl Chir 2004; 128:970-6. [PMID: 14669119 DOI: 10.1055/s-2003-44805] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Because of the high prevalence of coexisting medical conditions in patients with gastrointestinal cancer, clinical investigators often need to adjust for comorbidity when assessing the effect of comorbidity on patient outcome. Comorbidity in cancer has been shown to be a major determinant in treatment selection and survival. However, none of the comorbidity studies in patients with gastric cancer reported in the literature have been performed using the Charlson comorbidity index. The purpose of this study was to examine the applicability of the CCI and usefulness of the CCI as a predictor in patients with gastric cancer and to examine whether it correlates with short- term outcome in these patients. METHOD Study design was a prospective study. The study population was drawn from our department and included 139 patients who underwent curative treatment of gastric cancer between 1.1.1997 and 31.12.2001. All patients were staged by the CCI for comorbidity and divided into three groups based on the comorbidity severity staging. Group 1 included patients with no comorbidity, group 2 included those with low-level comorbidity and group 3 those with severe comorbidity. Outcomes were compared based on these divisions performing uni- and multivariate analysis. RESULTS 35 patients (25.2 %) had no, 55 (39.6 %) low and 39 (35.2 %) severe comorbidity. 28.8 % of patients showed no or mild, 14.4 % moderate and 14.4 % of patients severe postoperative complications and 5.8 % died in hospital postoperatively. 30-day-mortality was 3.6 % (n = 5). There was no statistical significant correlation between CCI and occurrence of postoperative complications, severity of postoperative course and postoperative stay in hospital. In multivariate analysis only age was an independent factor for postoperative course. CONCLUSION The method of classifying comorbidity by CCI provides a simple, readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies and in outcomes research from administrative databases. In gastric cancer, however, the CCI was found not to be a valid prognostic indicator.
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Affiliation(s)
- T Lübke
- Klinik und Poliklinik für Viszeral- und Gefässchirurgie der Universität zu Köln
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Hölscher AH, Bollschweiler E, Metzger R, Mönig SP. [D2 lymphadenectomy superior to d1 lymphadenectomy in gastric cancer surgery]. Zentralbl Chir 2003; 128:786-7. [PMID: 14628227 DOI: 10.1055/s-2003-44337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Flucke U, Steinborn E, Dries V, Mönig SP, Schneider PM, Thiele J, Hölscher AH, Dienes HP, Baldus SE. Immunoreactivity of cytokeratins (CK7, CK20) and mucin peptide core antigens (MUC1, MUC2, MUC5AC) in adenocarcinomas, normal and metaplastic tissues of the distal oesophagus, oesophago-gastric junction and proximal stomach. Histopathology 2003; 43:127-34. [PMID: 12877727 DOI: 10.1046/j.1365-2559.2003.01680.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIMS Adenocarcinomas of the distal oesophagus and especially the oesophago-gastric junction have shown an increasing incidence during the last decade. Definition of subgroups according to different sites of development, histogenesis or aetiology may prove to be valuable for clinical diagnosis and treatment. Previous studies have shown differences in cytokeratin patterns between Barrett's metaplasia of the oesophagus and intestinal metaplasia in the stomach. The aim of our study was to investigate whether the expression of certain cytokeratins (CK7, CK20) and mucins (MUC1, MUC2, MUC5AC) exhibit clear-cut patterns, thus allowing a subclassification of adenocarcinomas of the oesophago-gastric junction. The possibility of a relationship between antigen expression and the presence or absence of Barrett's metaplastic epithelium was also studied. METHODS AND RESULTS CK7, CK20, MUC1, MUC2 and MUC5AC were visualized in six adenocarcinomas of the distal oesophagus, 29 adenocarcinomas of the oesophago-gastric junction and eight adenocarcinomas of the proximal stomach. CK7, CK20 and MUC1 were strongly expressed in the great majority of all neoplasms under study, whereas MUC2 and MUC5AC were absent or only faintly detectable. CK20 exhibited a significantly stronger expression in poorly differentiated tumours (G3) and MUC1 immunoreactivity correlated with tubular and papillary versus signet-ring cell histopathology. Other statistically significant correlations between antigens and histopathological features (pTNM stage, grading, histopathological subtype, presence/absence of Barrett's epithelium) were not observed. CONCLUSIONS According to our results, most adenocarcinomas of the oesophago-gastric junction show a CK7+, CK20+, MUC1+ phenotype irrespective of the presence or absence of Barrett's epithelium. The immunohistochemical data suggest a similar histogenesis of these tumours.
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Affiliation(s)
- U Flucke
- Institute of Pathology, University of Cologne, Cologne, Germany
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Bollschweiler E, Schneider PM, Mönig SP, Altendorf-Hofmann A, Mansmann U, Lehmacher W, Schlag PM, Merkel S, Hohenberger W, Izbicki JR, Hermanek P, Hölscher AH. [Prognostic relevance of biological and molecular markers in oncology. Criteria for planning and interpreting studies]. Chirurg 2003; 74:139-44. [PMID: 12599032 DOI: 10.1007/s00104-002-0557-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Experts on different specialties (surgery, pathology, molecular biology and medical statistics) discussed the evaluation of prognostic factors during a workshop. The most important results presented are: (1) the prognostic relevance of new biological or molecular markers must be evaluated in a phase-III prognostic study. To establish such a marker in the UICC-TNM-classification in at least two different centers, two multivariate analyses according to defined criteria are necessary; (2) the standards of laboratory methods have to be defined, e.g.,which method to apply for RNA-analysis,which materials to used, etc; (3) intensive data analysis should be done before using methods of multivariate analysis. The criteria for the presentation of survival curves are given in detail; (4) in multivariate analysis, the Cox proportional hazard regression for survival outcomes is discussed with explanations and examples of the terms relative risk, odds-ratio, hazard and relative hazard. The arrangement and interpretation of a good prognostic study should be performed as an interdisciplinary approach.
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Affiliation(s)
- E Bollschweiler
- Klinik und Poliklinik für Visceral- und Gefässchirurgie der Universität zu Köln, Cologne.
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Affiliation(s)
- A H Hölscher
- Klinik und Poliklinik für Visceral- und Gefässchirurgie der Universität zu Köln.
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Schröder W, Mönig SP, Baldus SE, Gutschow C, Schneider PM, Hölscher AH. Frequency of nodal metastases to the upper mediastinum in Barrett's cancer. Ann Surg Oncol 2002; 9:807-11. [PMID: 12374665 DOI: 10.1007/bf02574504] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND In Barrett's cancer, the frequency of lymph node metastases to the middle and upper mediastinum has rarely been analyzed because it requires a complete mediastinal lymphadenectomy. METHODS Fifty-one patients with esophageal adenocarcinoma underwent transthoracic en-bloc esophagectomy with two-field lymph node dissection. A meticulous work-up of the resected specimen allowed a specific assignment of each single lymph node to defined groups of the abdominal and mediastinal compartment. Histopathology classified the lymph nodes as metastatic or nonmetastatic. RESULTS A total of 1706 lymph nodes were resected, with a mean of 33.5 lymph nodes per patient (range, 13-74). Of 51 patients, 28 (54.9%) were classified as pN1; 7 (25%) of 28 pN1 patients had nodal metastases at the level of the tracheal bifurcation (3 of 28 patients) or in the upper mediastinum (5 of 28 patients). In all 28 pN1 patients, the abdominal compartment was involved. The distribution of nodal metastases demonstrated that the main lymphatic spread occurred close to the primary tumor, along the lesser curvature and the left gastric artery. CONCLUSIONS Adenocarcinomas of the distal esophagus have a bidirectional lymphatic spread to the mediastinum and the abdomen. Two-field lymphadenectomy seems to be an adequate surgical approach for this tumor entity to achieve a complete nodal clearance.
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Affiliation(s)
- W Schröder
- Department of Visceral and Vascular Surgery, University of Cologne, Cologne, Germany.
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Mönig SP, Schröder W, Baldus SE, Hölscher AH. Preoperative lymph-node staging in gastrointestinal cancer--correlation between size and tumor stage. Oncol Res Treat 2002; 25:342-4. [PMID: 12232485 DOI: 10.1159/000066051] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Our data suggest that lymph-node size is not a reliable indicator for lymph-node metastasis in gastric, esophageal, and colon cancer. Despite a significant difference in diameter of metastatic and non-metastatic nodes, the accurate evaluation of lymph-node metastasis in gastro-intestinal carcinoma cannot be determined by nodal size, because the majority of counted lymph nodes is ?5 mm and the frequency of small lymph-node metastases is high. Therefore imaging techniques using the size as criterion of nodal infiltration can not exactly assess the nodal status of patients with gastro-intestinal carcinomas. For rational lymphadenectomy, the value of sentinel node biopsy in gastro-intestinal cancer is now discussed. At the moment it is too early to apply sentinel node biopsy in order to reduce the extent of lymphadenectomy in these carcinomas [11]. Recent interest has focused on PET scanning in the detection of lymph-node metastases. PET represents a potentially ideal imaging modality for malignancy. It allows a quick and simultaneous assessment of both local and distant sites and, as a result of avid uptake of the glucose moiety, may potentially identify small tumor loads. There are only limited experience in detecting lymph-node metastases in gastro-intestinal carcinoma and the results of the published reports are controversially discussed [12, 13]. Our data demonstrate a high frequency of small lymph-node metastases in gastro-intestinal carcinoma and suggest that a careful histological search for small lymph-node metastases should be undertaken to avoid false-negative lymph-node staging. These results emphasize that a reliable pathological staging of gastro-intestinal cancer must be based on a standardized systematic lymphadenectomy because lymph-node sampling based on lymph-node size is not sufficient.
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Affiliation(s)
- S P Mönig
- Department of Visceral and Vascular Surgery, University of Cologne, Cologne, Germany
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Baldus SE, Mönig SP, Hanisch FG, Zirbes TK, Flucke U, Oelert S, Zilkens G, Madejczik B, Thiele J, Schneider PM, Hölscher AH, Dienes HP. Comparative evaluation of the prognostic value of MUC1, MUC2, sialyl-Lewis(a) and sialyl-Lewis(x) antigens in colorectal adenocarcinoma. Histopathology 2002; 40:440-9. [PMID: 12010364 DOI: 10.1046/j.1365-2559.2002.01389.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS The significance of MUC1, MUC2 and sialylated Lewis blood group antigens as prognostic markers in colorectal adenocarcinoma was investigated in a large series of patients because previous investigations revealed inconsistent results due to unrelated tumour samples from different patient groups and methodological differences. METHODS AND RESULTS Tissues from 243 patients with colorectal adenocarcinoma were stained immunohistochemically. MUC1 showed a strong immunoreactivity (in more than 35% of the tumour area) in 32.5%, MUC2 in 51.0%, sialyl-Lewis(x) in 67.9% and sialyl-Lewis(a) in 73.7% of the cases, respectively. MUC1 immunoreactivity displayed a significant correlation with tumour progression as reflected by advancing pTNM staging and poor differentiation. MUC2 expression was significantly stronger in mucinous adenocarcinomas. Sialyl-Lewis(x) immunostaining correlated with the extent of lymph node metastasis as well as low cytological differentiation. According to univariate and multivariate analysis (P < 0.0001) only MUC1 reactivity represented a marker of worse survival probability, opposed to the sialylated Lewis antigens that did not exert a predictive value. CONCLUSIONS According to our data, MUC1 and sialyl-Lewis(x) immunoreactivity exhibit statistically significant correlations with established markers of tumour progression. However, only MUC1 presents as an independent prognostic factor of colorectal adenocarcinoma.
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Affiliation(s)
- S E Baldus
- Institute of Pathology, Medical Faculty, University of Cologne, Cologne, Germany.
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40
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Baldus SE, Mönig SP, Schneider PM, Hölscher AH, Dienes HP. [Adenocarcinoma of the stomach with heterotopic ossification. Case report and discussion of the pathogenesis]. Pathologe 2002; 23:156-60. [PMID: 12001533 DOI: 10.1007/s00292-002-0520-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Heterotopic ossification of gastric adenocarcinomas is very rarely observed in humans. In rats such lesions could be induced by ingestion of nitroso compounds. We describe the case of a 70-year-old patient with an extended, initially spleen-infiltrating tubular adenocarcinoma of the stomach with a mucinous component, heterotopic ossifications and pronounced regressive alterations after neoadjuvant chemotherapy. Various speculations regarding the pathogenesis of heterotopic ossifications in gastrointestinal adenocarcinomas are discussed.
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Affiliation(s)
- S E Baldus
- Zentrum für Pathologie, Universität zu Köln, Joseph-Stelzmann-Strasse 9, 50931 Köln.
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41
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Baldus SE, Zirbes TK, Glossmann J, Fromm S, Hanisch FG, Mönig SP, Schröder W, Schneider PM, Flucke U, Karsten U, Thiele J, Hölscher AH, Dienes HP. Immunoreactivity of monoclonal antibody BW835 represents a marker of progression and prognosis in early gastric cancer. Oncology 2002; 61:147-55. [PMID: 11528254 DOI: 10.1159/000055366] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The Thomsen-Friedenreich (TF) antigen is a well-known human pan-carcinoma antigen. It represents a carbohydrate core disaccharide (Gal beta 1-3GalNAc) which is predominantly bound to mucin peptide cores. Its immunoreactivity depends on changes in glycosylation which lead to a reduction in the carbohydrate chain length and the exposure of core carbohydrates. In the present study, we investigated 208 gastric adenocarcinomas with respect to their immunohistochemical reactivity applying two monoclonal antibodies (MAbs). MAb specifically detecting TF antigen (A78-G/A7) and MAb BW835 were included. The latter reacts with a certain glycoform of the MUC1 peptide core, characterized by core-type glycans like TF. A78-G/A7 epitopes were detected in 68.8% and BW835 epitopes in 57.7% of the carcinomas. BW835 immunoreactivity correlated with the presence of lymph node metastases. Both A78-G/A7 and BW835 staining were significantly stronger in tubular/papillary cancer (WHO classification) and intestinal-type cancer according to Laurén. In univariate survival analyses of all patients studied, BW835 immunoreactivity was a marker of an unfavorable prognosis (p < 0.05). The presence of A78-G/A7 and BW835 epitopes exerted a negative effect on the subgroup of pTNM stage I carcinomas. These results indicate that TF and MUC1-TF immunoreactivity defines a 'high-risk' subgroup of stage I patients in gastric cancer.
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MESH Headings
- Adenocarcinoma/chemistry
- Adenocarcinoma/classification
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/immunology
- Antibody Specificity
- Antigens, Neoplasm/analysis
- Antigens, Neoplasm/chemistry
- Antigens, Neoplasm/immunology
- Antigens, Tumor-Associated, Carbohydrate/analysis
- Antigens, Tumor-Associated, Carbohydrate/immunology
- Biomarkers, Tumor/analysis
- Disease Progression
- Epitopes/analysis
- Epitopes/immunology
- Female
- Glycosylation
- Humans
- Immunoenzyme Techniques
- Life Tables
- Lymphatic Metastasis
- Male
- Middle Aged
- Mucin-1/analysis
- Mucin-1/chemistry
- Mucin-1/immunology
- Multivariate Analysis
- Neoplasm Proteins/analysis
- Neoplasm Proteins/chemistry
- Neoplasm Proteins/immunology
- Neoplasm Staging
- Prognosis
- Protein Isoforms/analysis
- Protein Isoforms/chemistry
- Protein Isoforms/immunology
- Protein Processing, Post-Translational
- Retrospective Studies
- Risk
- Stomach Neoplasms/chemistry
- Stomach Neoplasms/mortality
- Stomach Neoplasms/pathology
- Survival Analysis
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Affiliation(s)
- S E Baldus
- Institute of Pathology, University of Cologne, Germany.
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42
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Baldus SE, Hanisch FG, Pütz C, Flucke U, Mönig SP, Schneider PM, Thiele J, Hölscher AH, Dienes HP. Immunoreactivity of Lewis blood group and mucin peptide core antigens: correlations with grade of dysplasia and malignant transformation in the colorectal adenoma-carcinoma sequence. Histol Histopathol 2002; 17:191-8. [PMID: 11813869 DOI: 10.14670/hh-17.191] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Previous studies on the immunoreactivity of various mucin peptide and carbohydrate antigens in neoplastic colorectal tissues led to at least in part contradictory results. Therefore, we investigated a series of 42 adenomas and 44 carcinomas applying monoclonal antibodies (mabs) directed against Lewis blood group antigens (sialyl-Le(a), Le(x), sialyl-Le(x), Le(y)) as well as mucin peptide cores (MUC1, MUC2 and MUC5AC) by immunohistochemistry. A statistically significant positive correlation between the development of high-grade dysplasia in colorectal adenomas and the immunoreactivity of Le(y) and MUC1 epitopes was observed, whereas MUC2 exhibited a significant negative correlation. The reactivity of the other epitopes did not show an association with the progression of malignant transformation. Colorectal carcinomas were subdivided according to their histopathological subtype. The immunohistochemical staining resulted in a significantly stronger MUC2 reactivity of mucinous vs. tubular adenocarcinomas. Immunoreactivity of the MUC1-specific mab, which does not react with the fully glycosylated peptide core, showed a statistically non-significant inverse tendency, whereas all carbohydrate antigens displayed a strong expression in both tumor subtypes. Furthermore, correlations between mucin peptide and carbohydrate epitope labelling were evaluated. Progression of the adenoma-carcinoma sequence was accompanied by an increase of Le(y) as well as MUC1 antigen and an increase of all Lewis antigens compared to MUC2 immunoreactivity. On the other hand, mucinous carcinomas exhibited an inverse pattern. In conclusion, these results demonstrate that Le(y) and MUC1 immunoreactivity correlate with malignant transformation in the colorectum, whereas MUC2 represents a marker for low-grade dysplasia and the subtype of mucinous carcinomas.
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Affiliation(s)
- S E Baldus
- Institute of Pathology, University of Cologne, Germany.
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43
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Mönig SP, Baldus SE, Hennecken JK, Spiecker DB, Grass G, Schneider PM, Thiele J, Dienes HP, Hölscher AH. Expression of MMP-2 is associated with progression and lymph node metastasis of gastric carcinoma. Histopathology 2001; 39:597-602. [PMID: 11903578 DOI: 10.1046/j.1365-2559.2001.01306.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIMS One important step in tumour invasion is the penetration of the basement membrane. Matrix metalloproteinases (MMPs) play a key role in the migration of normal and malignant cells through the basement membrane. The aim of this study was to investigate correlations between matrix metalloproteinase 2 (MMP-2) immunoreactivity and currently used classification systems and possible relationships between lymph node metastasis and MMP-2 expression. METHODS AND RESULTS This prospective study analysed specimens obtained from 114 gastric cancer patients (mean age 64 years; range 33-86 years) who underwent gastrectomy with extended lymphadenectomy. All specimens were categorized according to UICC classification, WHO classification, tumour differentiation, Laurén classification, Ming classification and Goseki classification. Formalin-fixed paraffin-embedded tumour specimens were stained using an avidin-biotin complex peroxidase assay. MMP-2 expression in the tumour epithelium was studied by immunohistochemistry with semiquantitative (score 0-3) evaluation. The MMP-2 staining pattern was positive (score 1-3) in 93 (81.6%) specimens and negative (score 0) in 21 (18.4%) samples. No significant correlations were found between MMP-2 expression and other variables such as age, tumour differentiation, WHO, Lauren, Goseki, and Ming classifications. In contrast, the intensity of MMP-2 staining in tumour cells correlated significantly with depth of tumour infiltration (T-stage), lymph node metastasis (N-stage), distant metastasis (M-stage), and UICC stage. CONCLUSIONS Expression of MMP-2 is strongly associated with tumour progression and lymph node metastasis in gastric cancer. Therefore MMP-2 staining may be clinically useful as predictor of tumour progression, especially for lymph node metastasis.
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Affiliation(s)
- S P Mönig
- Department of Surgery, University of Cologne, Joseph-Stelzmann-Strasse 9, 50924 Cologne, Germany.
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44
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Hölscher AH, Mönig SP, Schneider PM. [What's new in upper gastrointestinal tract surgery?]. Zentralbl Chir 2001; 126:863-5. [PMID: 11753793 DOI: 10.1055/s-2001-19150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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45
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Mönig SP, Schröder W, Beckurts KT, Hölscher AH. Classification, diagnosis and surgical treatment of carcinomas of the gastroesophageal junction. Hepatogastroenterology 2001; 48:1231-7. [PMID: 11677937] [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: 04/17/2023]
Abstract
The incidence of adenocarcinoma of the gastroesophageal junction has risen faster than that of any other malignancy in various western countries. Adenocarcinoma of the gastroesophageal junction can be topographically classified into three types: carcinomas of the distal esophagus (type I), true carcinomas of the cardia (type II) and carcinomas of the subcardial region (type III). This surgical classification has proven to be of value for planning the extent of resection and for comparing epidemiologic data and therapeutic results of different series. The preoperative assignment is achieved by contrast X-ray and endoscopy and enables the surgeon to plan preoperatively the adequate extent of the resection. The type I-adenocarcinoma represents a distal esophageal cancer and consequently is treated by esophageal resection as transhiatal subtotal radical esophagectomy or in case of more proximal carcinoma by transthoracic en bloc esophagectomy. The type II- and type III-adenocarcinomas are treated by a gastrectomy and distal esophageal resection with D2-lymphadenectomy via an abdominal and transhiatal approach. In case of an advanced carcinoma with high risk of incomplete resection, neoadjuvant radiochemotherapy should be taken into consideration.
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Affiliation(s)
- S P Mönig
- Department of Visceral and Vascular Surgery, University of Cologne, Joseph-Stelzmann Str. 9, 50924 Cologne, Germany
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46
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Baldus SE, Schneider PM, Mönig SP, Zirbes TK, Fromm S, Meyer W, Glossmann J, Schüler S, Thiele J, Hölscher AH, Dienes HP. p21/waf1/cip1 in gastric cancer: associations with histopathological subtypes, lymphonodal metastasis, prognosis and p53 status. Scand J Gastroenterol 2001; 36:975-80. [PMID: 11521990 DOI: 10.1080/003655201750305512] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cyclins and cyclin-dependent kinases are determining factors of the cell cycle. In the present study, we investigated the role of p21 and p53 in the biology of gastric cancer, focusing on its influence on progression and prognosis (n = 195). METHODS P21 and p53 immunoreactivity was analysed immunohistochemically, applying monoclonal antibodies. The p53 status was comparatively evaluated by PCR-SSCP analysis of p53 mutations in selected tumours. RESULTS Fifty-eight percent of the carcinomas were p21+ in more than 5% of the cancer cell nuclei, whereas 19% exhibited a p21 immunoreactivity in more than 20% of the nuclei. On the other hand, p53 was over-expressed (in more than 50% of the nuclei) in about 45% of the specimens. P21 immunoreactivity in more than 5% of the nuclei was inversely related to the pN as well as pTNM cancer stage, whereas only a strong p21 expression (in >20% of the nuclei) was correlated with a better survival probability in a univariate analysis. The p53 status was associated with lymphonodal metastasis, but not with prognostic data. In multivariate survival analyses, neither p21 nor p53 emerged as independent prognostic factors. Compared with the results of p53 mutation analysis by PCR-SSCP. p21 immunoreactivity was reduced in p53-mutated cases. CONCLUSIONS These features show an association of p21 over-expression with certain clinico-pathological parameters of gastric cancer. In this context, our data suggest that p21 immunoreactivity in more than 5% of the tumour cells has a predictive value for the course of adenocarcinoma of the stomach.
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Affiliation(s)
- S E Baldus
- Institute of Pathology, University of Cologne, Germany.
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47
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Schröder W, Baldus SE, Mönig SP, Zirbes TK, Beckurts TK, Hölscher AH. Lesser curvature lymph node metastases with esophageal squamous cell carcinoma: implications for gastroplasty. World J Surg 2001; 25:1125-8. [PMID: 11571946 DOI: 10.1007/bf03215858] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The creation of a gastric tube after subtotal esophagectomy includes resection of the lesser curvature and abdominal lymph nodes. The fundus rotation gastroplasty has been recently proposed as an alternative technique of reconstruction that preserves the vascular arcade of the lesser curvature. This study investigates the number of resected and metastatic lymph nodes associated with abdominal lymphadenectomy to assess the oncologic radicality of fundus rotation gastroplasty. In this prospective clinical trial a two-field lymphadenectomy was performed in 39 patients with squamous cell carcinoma of the esophagus. The abdominal lymphadenectomy included partial resection of compartment I (lymph node groups 1, 2, and 3) and compartment II (lymph node groups 7, 8, 9, and 11). A meticulous workup of the specimen allowed an exact classification of specific lymph node groups and their metastatic status. After two-field lymphadenectomy a total of 1170 lymph nodes (average 30.0) including 690 abdominal lymph nodes with an average of 17.7 per patient were resected. Metastatic disease was found in 27 of 39 patients (pN1 69.2%), with metastatic growth in 116 of 867 resected lymph nodes (13.4%). Of the 27 pN1 patients, 21 had abdominal lymph node metastases. Metastatic lymph nodes at the lesser curvature (groups 1, 3, and 7) were detected in 11.7%, 16.7%, and 29.7% of the resected lymph nodes, respectively. Of the 21 patients (85.7%) with abdominal lymph node metastases, 18 had positive lymph nodes at the lesser curvature. Squamous cell carcinoma of the esophagus is associated with a high rate of lymph node metastases at the lesser curvature and the left gastric artery. Therefore preservation of the lesser curvature and the left gastric artery for gastroplasty reduces the radicality regarding lymph node metastases.
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Affiliation(s)
- W Schröder
- Department of Visceral and Vascular Surgery, University of Cologne, Joseph-Stelzmann Strasse 9, 50931 Cologne, Germany
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48
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Flucke U, Zirbes TK, Schröder W, Mönig SP, Koch V, Schmitz K, Thiele J, Dienes HP, Hölscher AH, Baldus SE. Expression of mucin-associated carbohydrate core antigens in esophageal squamous cell carcinomas. Anticancer Res 2001; 21:2189-93. [PMID: 11501845] [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: 02/21/2023]
Abstract
In contrast to gastrointestinal cancer, where a correlation between the expression of different mucin-associated core antigens with clinico-pathological parameters and survival probability, has been established, little is known about their importance in esophageal cancer. Therefore, we characterized esophageal squamous cell carcinomas from 84 patients immunohistochemically by applying monoclonal antibodies (mabs) directed against the Thomsen-Friedenreich (TF) antigen MUC1-bound TF antigen and sialyl-Tn. TF was observed in about 40% of the cases and MUC1-TF epitope in about 75%. Sialyl-Tn was detectable in about half of the carcinomas under study. None of these mabs showed any correlation between binding pattern and clinico-pathological variables, such as TNM stage, lymph node metastasis or grading. However, a strong expression of MUC1-TF epitope as well as sialyl-Tn antigen predicted a poor survival probability. In conclusion, it is suggested that mucin-associated carbohydrate core antigens are involved in the biology and clinical course of esophageal squamous carcinomas.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal
- Antigens, Tumor-Associated, Carbohydrate/biosynthesis
- Antigens, Tumor-Associated, Carbohydrate/metabolism
- Biomarkers, Tumor/biosynthesis
- Carcinoma, Squamous Cell/immunology
- Carcinoma, Squamous Cell/metabolism
- Carcinoma, Squamous Cell/pathology
- Esophageal Neoplasms/immunology
- Esophageal Neoplasms/metabolism
- Esophageal Neoplasms/pathology
- Female
- Humans
- Immunohistochemistry
- Male
- Middle Aged
- Mucin-1/immunology
- Mucin-1/metabolism
- Neoplasm Staging
- Prognosis
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Affiliation(s)
- U Flucke
- Institute of Pathology and Department of Visceral and Vascular Surgery, University of Cologne, Germany
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49
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Mönig SP, Collet PH, Baldus SE, Schmackpfeffer K, Schröder W, Thiele J, Dienes HP, Hölscher AH. Splenectomy in proximal gastric cancer: frequency of lymph node metastasis to the splenic hilus. J Surg Oncol 2001. [PMID: 11223832 DOI: 10.1002/1096-9098(200102)76:2%3c89::aid-jso1016%3e3.0.co;2-i] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVES The indication for splenectomy in proximal gastric cancer remains controversial. Splenectomy is performed because of possible lymph node metastasis of the splenic hilus or infiltration/metastasis of the spleen. The purpose of this study was to investigate the frequency of lymph node metastasis to the splenic hilus and metastasis to the spleen in proximal gastric carcinomas. METHODS In a morphologic study, the frequency of lymph node metastasis to the splenic hilus in 112 patients with proximal gastric cancer was investigated with particular emphasis on its correlation with established clinicopathological characteristics and classifications. Seventy-seven gastrectomy specimens were obtained from men and 35 from women. Patients ranged in age from 20 to 89 years (median 60 years). All patients underwent a potential curative resection (RO resection) with total gastrectomy and pancreas-preserving splenectomy. None of the patients had been treated preoperatively with cytotoxic drugs or radiation. RESULTS A mean number of three lymph nodes (range 0-8) in the splenic hilus was found in each specimen. The incidence of lymph node metastasis of the splenic hilus was 9.8% (n=11). Lymph node metastasis was only observed in advanced proximal gastric cancer (UICC IIIb/IV) located at the greater curvature and in Borrmann type III/IV cancer with advanced lymph node metastasis. An infiltration of the spleen was seen only in two cases with advanced stages of gastric carcinoma (stage IV). CONCLUSIONS Based on our data lymph node metastasis to the splenic hilus is rarely observed in proximal gastric cancer and only found in advanced cancer (UICC IIIb/IV) especially in tumors of the greater curvature and of Borrmann type IV cancer.
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Affiliation(s)
- S P Mönig
- Department of Visceral and Vascular Surgery, University of Cologne, Cologne, Germany.
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50
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Mönig SP, Collet PH, Baldus SE, Schmackpfeffer K, Schröder W, Thiele J, Dienes HP, Hölscher AH. Splenectomy in proximal gastric cancer: frequency of lymph node metastasis to the splenic hilus. J Surg Oncol 2001. [PMID: 11223832 DOI: 10.1002/1096-9098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVES The indication for splenectomy in proximal gastric cancer remains controversial. Splenectomy is performed because of possible lymph node metastasis of the splenic hilus or infiltration/metastasis of the spleen. The purpose of this study was to investigate the frequency of lymph node metastasis to the splenic hilus and metastasis to the spleen in proximal gastric carcinomas. METHODS In a morphologic study, the frequency of lymph node metastasis to the splenic hilus in 112 patients with proximal gastric cancer was investigated with particular emphasis on its correlation with established clinicopathological characteristics and classifications. Seventy-seven gastrectomy specimens were obtained from men and 35 from women. Patients ranged in age from 20 to 89 years (median 60 years). All patients underwent a potential curative resection (RO resection) with total gastrectomy and pancreas-preserving splenectomy. None of the patients had been treated preoperatively with cytotoxic drugs or radiation. RESULTS A mean number of three lymph nodes (range 0-8) in the splenic hilus was found in each specimen. The incidence of lymph node metastasis of the splenic hilus was 9.8% (n=11). Lymph node metastasis was only observed in advanced proximal gastric cancer (UICC IIIb/IV) located at the greater curvature and in Borrmann type III/IV cancer with advanced lymph node metastasis. An infiltration of the spleen was seen only in two cases with advanced stages of gastric carcinoma (stage IV). CONCLUSIONS Based on our data lymph node metastasis to the splenic hilus is rarely observed in proximal gastric cancer and only found in advanced cancer (UICC IIIb/IV) especially in tumors of the greater curvature and of Borrmann type IV cancer.
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Affiliation(s)
- S P Mönig
- Department of Visceral and Vascular Surgery, University of Cologne, Cologne, Germany.
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