1
|
Hölscher AH, Bollschweiler E, Fetzner UK, Babic B. Surgical approach to advanced Siewert II cancer: beyond the borders? The West Side. Updates Surg 2023; 75:329-333. [PMID: 36001282 DOI: 10.1007/s13304-022-01363-w] [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] [Received: 08/04/2022] [Accepted: 08/13/2022] [Indexed: 01/24/2023]
Abstract
The surgical approach to Siewert type II cancer should be individualized as there is no "one size fits all" option. Criteria for individualization are epidemiological, functional, oncologic and surgical items. However, our preferred procedure for advanced adenocarcinoma of the esophagogastric junction type II is esophagectomy, if this or transhiatal extended gastrectomy are both possible with R0 resection. Esophagectomy has the advantages of a longer esophageal safety margin, complete mediastinal lymphadenectomy, easier anastomosis, routine minimal invasive gastrolysis with abdominal lymphadenectomy and preservation of a gastric reservoir.
Collapse
Affiliation(s)
- Arnulf H Hölscher
- Center for Esophagogastric Cancer Surgery, St. Elisabethen Hospital Frankfurt, Ginnheimer Str. 3, 60487, Frankfurt, Germany.
| | | | - Ulrich K Fetzner
- Clinic for General Surgery, Visceral-, Thoracic-, Paediatric- and Endocrine Surgery, Johannes Wesling Clinic, University Clinic of the Ruhr University Bochum, Minden, Germany
| | - Benjamin Babic
- Center for Esophagogastric Cancer Surgery, St. Elisabethen Hospital Frankfurt, Ginnheimer Str. 3, 60487, Frankfurt, Germany
| |
Collapse
|
2
|
Talavera-Urquijo E, Davies AR, Wijnhoven BPL. Prevention and treatment of a positive proximal margin after gastrectomy for cardia cancer. Updates Surg 2023; 75:335-341. [PMID: 35842570 PMCID: PMC9852102 DOI: 10.1007/s13304-022-01315-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/14/2022] [Indexed: 01/24/2023]
Abstract
A tumour-positive proximal margin (PPM) after extended gastrectomy for oesophagogastric junction (OGJ) adenocarcinoma is observed in approximately 2-20% of patients. Although a PPM is an unfavourable prognostic factor, the clinical relevance remains unclear as it may reflect poor tumour biology. This narrative review analyses the most relevant literature on PPM after gastrectomy for OGJ cancers. Awareness of the risk factors and possible measures that can be taken to reduce the risk of PPM are important. In patients with a PPM, surgical and non-surgical treatments are available but the effectiveness remains unclear.
Collapse
Affiliation(s)
- Eider Talavera-Urquijo
- grid.414651.30000 0000 9920 5292Department of Surgery, University Hospital of Donostia, Donostia-San Sebastián, Spain
| | - Andrew R. Davies
- grid.420545.20000 0004 0489 3985Department of Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Bas P. L. Wijnhoven
- grid.5645.2000000040459992XDepartment of Surgery, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
3
|
Saito MK, Nakata K, Kato M, Kuwabara Y, Morishima T, Rachet B, Miyashiro I. Trends in age-standardised net survival of stomach cancer by subsite and stage: A population-based study in Osaka, Japan, 2001-2014. Cancer Epidemiol 2022; 79:102170. [PMID: 35525121 DOI: 10.1016/j.canep.2022.102170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/04/2022] [Accepted: 04/26/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The burden of stomach cancer remains high, particularly among Asian countries. Although Japan is known to achieve high survival from stomach cancer, little is known regarding the survival trends for recent years and survival by subsite and stage. We report age-standardised 1-, 3-, 5- and 10-year net survival for patients diagnosed with stomach cancer in Osaka, Japan. METHODS We analysed patients diagnosed with primary stomach cancer and registered in the population-based cancer registry in Osaka Prefecture between 2001 and 2014. We used the non-parametric Pohar Perme method to derive net survival for each year. Both cohort and period approaches were used. Age was standardised using weights of the external population of the International Cancer Survival Standard. Multiple imputation was applied to handle missing information on subsite and stage before estimating age-standardised net survival by subsite (cardia and non-cardia) and stage (localised, regional and distant metastasis). We then examined general trends in the cohort-based survival estimates, as well as by subsite and stage, using linear regression. RESULTS A total of 97,276 patients were included in the analysis. Age-standardised net survival improved steadily (mean annual absolute change ≥1.2%). Net survival for both subsites improved, but cardia cancer showed 7-23% lower survival than non-cardia cancer throughout the study period. Five-year net survival remained high (≥80%) in the localised stage from the beginning of this study. Net survival increased steeply (≥1.4% per year) in the regional stage. Although 1-year net survival increased by 14% in the distant stage, 5-year and 10-year net survival remained below 10%. CONCLUSION Age-standardised net survival for stomach cancer in Japan improved during the study period owing to an increase in the number of patients with localised stage at diagnosis and improved treatment. Monitoring both short- and long-term survival should be continued as management of stomach cancer progresses.
Collapse
Affiliation(s)
- Mari Kajiwara Saito
- Department of Cancer Strategy, Cancer Control Center, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka City, Osaka Prefecture 541-8567, Japan.
| | - Kayo Nakata
- Department of Cancer Strategy, Cancer Control Center, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka City, Osaka Prefecture 541-8567, Japan.
| | - Mizuki Kato
- Department of Cancer Strategy, Cancer Control Center, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka City, Osaka Prefecture 541-8567, Japan.
| | - Yoshihiro Kuwabara
- Department of Cancer Strategy, Cancer Control Center, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka City, Osaka Prefecture 541-8567, Japan.
| | - Toshitaka Morishima
- Department of Cancer Strategy, Cancer Control Center, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka City, Osaka Prefecture 541-8567, Japan.
| | - Bernard Rachet
- Inequalities in Cancer Outcome Network, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
| | - Isao Miyashiro
- Department of Cancer Strategy, Cancer Control Center, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka City, Osaka Prefecture 541-8567, Japan.
| |
Collapse
|
4
|
Bornschein J, Quante M, Jansen M. The complexity of cancer origins at the gastro-oesophageal junction. Best Pract Res Clin Gastroenterol 2021; 50-51:101729. [PMID: 33975686 DOI: 10.1016/j.bpg.2021.101729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/22/2020] [Accepted: 02/08/2021] [Indexed: 01/31/2023]
Abstract
Chronic acid-biliary reflux and Helicobacter pylori infection are instrumental environmental drivers of cancer initiation and progression in the upper gastrointestinal tract. Remarkably, although these environmental carcinogens are quite dissimilar, the tumour progression cascade these carcinogens engender is highly comparable. For this reason, studies of malignant progression occurring at the anatomic borderland between the oesophagus and the stomach have traditionally lumped junctional adenocarcinomas with either oesophageal adenocarcinoma or gastric adenocarcinoma. Whilst studies have revealed remarkable epidemiological and genetic similarities of these cancers and their associated premalignant conditions, these works have also revealed some key differences. This highlights that further scientific effort demands a dedicated focus on the understanding of the cell-cell interaction between the epithelium and the local microenvironment in this anatomic region. We here review available evidence with regards to tumour progression occurring at the gastro-oesophageal junction and contrast it with available data on cancer evolution in the metaplastic oesophagus and distal stomach.
Collapse
Affiliation(s)
- Jan Bornschein
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom and NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom.
| | - Michael Quante
- Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Germany
| | | |
Collapse
|
5
|
Reddavid R, Strignano P, Sofia S, Evangelista A, Deiro G, Cannata G, Chiaro P, Maiello F, Mineccia M, Ferrero A, Leli R, Gentilli S, Polastri R, Borghi F, Camandona M, Romagnoli R, Morino M, Degiuli M. Transhiatal distal esophagectomy for Siewert type II cardia cancer can be a treatment option in selected patients. Eur J Surg Oncol 2019; 45:1943-1949. [PMID: 31005469 DOI: 10.1016/j.ejso.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Received: 08/23/2018] [Revised: 12/28/2018] [Accepted: 04/01/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND While surgical treatment of Siewert I and III (S1,S3) Esophagogastric Junction (EGJ) cancer is codified, the efficay of transhiatal procedure with anastomosis in the lower mediastinum for Siewert II (S2) still remains a dibated topic. METHODS This is a large multicenter retrospective study. The results of 598 consecutive patients submitted to resection with curative intent from January 2000 to January 2017 were reported. Clinical and oncological outcomes of different procedures performed in S2 tumor were analyzed to investigate the efficacy of transhiatal approach. RESULTS The 5-year overall survival rate (OS) was poor (32%) for all Siewert types. The most performed operations in S2 cancer were proximal gastrectomy + transthoracic esophagectomy (TTE or Ivor-Lewis procedure, 60%), total gastrectomy + transhiatal distal esophagectomy with anastomosis in the chest (THE, 24%) and total gastrectomy + transthoracic esophagectomy (TGTTE, 15%). Cardiovascular and pulmonary complications were higher after TTE. On the contrary, surgical complications were significantly higher after THE. Postoperative mortality was similar. The distribution of TNM stages was different in the 3 types of procedures: patients submitted to THE had an earlier stage disease. With this bias, OS after THE was higher than after TTE but the difference was not significant (49.85% vs 28.42%, p = 0.0587). CONCLUSIONS Despite a higher rate of postoperative surgical complications, OS after total gastrectomy and transhiatal distal esophagectomy was at least comparable to that of transthoracic approach in less advanced S2 tumors. Therefore, THE with anastomosis in the chest could be a treatmen option in earlier S2 tumors.
Collapse
Affiliation(s)
- Rossella Reddavid
- University of Turin. Department of Oncology, Surgical Oncology and Digestive Surgery Unit, San Luigi University Hospital (S.L.U.H.), Regione Gonzole 10, 10049, Orbassano, Turin, Italy
| | - Paolo Strignano
- University of Turin, Department os Surgical Sciences, Unit of General Surgery 2U, Ospedale Molinette, AOU Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy
| | - Silvia Sofia
- University of Turin. Department of Oncology, Surgical Oncology and Digestive Surgery Unit, San Luigi University Hospital (S.L.U.H.), Regione Gonzole 10, 10049, Orbassano, Turin, Italy
| | - Andrea Evangelista
- Unit of Clinical Epidemiology, AOU Città della Salute e della Scienza di Torino and Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica in Piemonte (CPO), Corso Bramante 88, 10126, Turin, Italy
| | - Giacomo Deiro
- University of Eastern Piedmont, Department of Health Sciences, General Surgery Unit Ospedale Maggiore della Carita, Corso Mazzini 18, 28100, Novara, Italy
| | - Gaspare Cannata
- Unit of General and Oncological Surgery, Department of Surgery, ASO SS Croce e Carle, V Coppino 26, 12100, Cuneo, Italy
| | - Paolo Chiaro
- Unit of General Surgery, Ospedale S Giovanni Bosco, Piazza del Donatore di Sangue 3, 10154, Turin, Italy
| | - Fabio Maiello
- Department of General Surgery, Ospedale degli Infermi di Biella, Via dei Ponderanesi 2, 13900, Ponderano, Biella, Italy
| | - Michela Mineccia
- Department of General and Oncological Surgery, Ospedale Umberto I di Torino (Mauriziano), Corso Turati 62, 10128, Turin, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Ospedale Umberto I di Torino (Mauriziano), Corso Turati 62, 10128, Turin, Italy
| | - Renzo Leli
- Unit of General Surgery, Ospedale S Giovanni Bosco, Piazza del Donatore di Sangue 3, 10154, Turin, Italy
| | - Sergio Gentilli
- University of Eastern Piedmont, Department of Health Sciences, General Surgery Unit Ospedale Maggiore della Carita, Corso Mazzini 18, 28100, Novara, Italy
| | - Roberto Polastri
- Department of General Surgery, Ospedale degli Infermi di Biella, Via dei Ponderanesi 2, 13900, Ponderano, Biella, Italy
| | - Felice Borghi
- Unit of General and Oncological Surgery, Department of Surgery, ASO SS Croce e Carle, V Coppino 26, 12100, Cuneo, Italy
| | - Michele Camandona
- University of Turin, Department os Surgical Sciences, Unit of Digestive and Oncological Surgery 1U, Ospedale Molinette, AOU Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy
| | - Renato Romagnoli
- University of Turin, Department os Surgical Sciences, Unit of General Surgery 2U, Ospedale Molinette, AOU Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy
| | - Mario Morino
- University of Turin, Department os Surgical Sciences, Unit of Digestive and Oncological Surgery 1U, Ospedale Molinette, AOU Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy
| | - Maurizio Degiuli
- University of Turin. Department of Oncology, Surgical Oncology and Digestive Surgery Unit, San Luigi University Hospital (S.L.U.H.), Regione Gonzole 10, 10049, Orbassano, Turin, Italy.
| |
Collapse
|
6
|
Ren J, Hao Y, Peng C. A case report of cardia cancer complicated with idiopathic muscular hypertrophy of the oesophagus treated with thoracoscopic surgery. J Minim Access Surg 2017; 14:158-160. [PMID: 29067940 PMCID: PMC5869978 DOI: 10.4103/jmas.jmas_164_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The incidence of idiopathic muscular hypertrophy of oesophagus (IMHE) is low, and <100 cases of IMHE have been reported. IMHE is a benign oesophageal disease, characterised by hyperplasia of all layers of the wall and in particular, muscle layer. Only a few cases have been reported regarding its clinical symptoms and images. In this present case, we report a cardia cancer with IMHE, showing significant hypertrophy of muscular layer of middle part of the oesophagus and successfully treated with minimally invasive thoracoscopic surgery.
Collapse
Affiliation(s)
- Jun Ren
- Department of General Surgery, Jiyang People's Hospital, Jinan, China
| | - Yingtao Hao
- Department of Thoracic, The Second Hospital of Shandong University, Jinan, China
| | - Chuanliang Peng
- Department of Thoracic, The Second Hospital of Shandong University, Jinan, China
| |
Collapse
|
7
|
Kauppila JH, Lagergren J. The surgical management of esophago-gastric junctional cancer. Surg Oncol 2016; 25:394-400. [PMID: 27916171 DOI: 10.1016/j.suronc.2016.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/04/2016] [Accepted: 09/13/2016] [Indexed: 12/14/2022]
Abstract
The best available surgical strategy in the treatment of resectable esophago-gastric junctional (EGJ) cancer is a controversial topic. In this review we evaluate the current literature and scientific evidence examining the surgical treatment of locally advanced EGJ cancer by comparing esophagectomy with gastrectomy, transhiatal with transthoracic esophagectomy, minimally invasive with open esophagectomy, and less extensive with more extensive lymphadenectomy. We also assess endoscopic procedures increasingly used for early EGJ cancer. The current evidence does not favor any of the techniques over the others in terms of oncological outcomes. Health-related quality of life may be better following gastrectomy compared to esophagectomy. Minimally invasive procedures might be less prone to surgical complications. Endoscopic techniques are safe and effective alternatives for early-stage EGJ cancer in the short term, but surgical treatment is the mainstay in fit patients due to the risk of lymph node metastasis. Any benefit of lymphadenectomy extending beyond local or regional nodes is uncertain. This review demonstrates the great need for well-designed clinical studies to improve the knowledge in how to optimize and standardize the surgical treatment of EGJ cancer.
Collapse
Affiliation(s)
- Joonas H Kauppila
- Department of Surgery and Medical Research Center Oulu, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Oulu University Hospital, P.O. Box 21, 90029 Oulu, Finland; Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden.
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden; Division of Cancer Studies, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| |
Collapse
|
8
|
Nie P, Ma HT, Wang JH, Su FD. Esophagogastric anterior wall anastomosis combined with pyloroplasty after surgery for early cardia cancer. Shijie Huaren Xiaohua Zazhi 2016; 24:749-753. [DOI: 10.11569/wcjd.v24.i5.749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the effect of two different digestive tract reconstruction procedures after surgery for early cardia cancer on postoperative quality of life.
METHODS: One hundred and five patients who underwent surgery for early cardia cancer were randomly divided into an observation group (esophagogastric anterior wall anastomosis combined with pyloroplasty, 55 cases) and a control group (esophagogastric posterior wall anastomosis combined with lip type embedding, 50 cases). The patients were followed for 6 mo postoperatively. Operation time, hospital stay, postoperative reflux esophagitis, and anastomotic stenosis were compared between the two groups.
RESULTS: Clinical cure was achieved in all patients in the two groups. Operation time and postoperative hospital stay showed no statistically significant difference between the observation group and control group (151.00 min ± 6.03 min vs 149.00 min ± 7.02 min, 16.15 d ± 3.13 d vs 15.27 d ± 3.06 d, P > 0.05). The incidences of reflux esophagitis and anastomotic stenosis were significantly lower in the observation group than in the control group [18.2% (10/55) vs 56.0% (28/50), 1.8% (1/55) vs 22.0% (11/50), P < 0.05].
CONCLUSION: Esophagogastric anterior wall anastomosis combined with pyloroplasty is an ideal digestive tract reconstruction procedure after surgery for early cardia cancer.
Collapse
|
9
|
Hong L, Guo XD, Lv J, Wang YS, Li YD. Effects of transthoracic vs transabdominal hiatal approaches for treatment of esophago-gastric junction adenocarcinoma. Shijie Huaren Xiaohua Zazhi 2014; 22:3963-3967. [DOI: 10.11569/wcjd.v22.i26.3963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the effects of transthoracic and transabdominal hiatal approaches for the treatment of Siewert types Ⅱ and Ⅲ adenocarcinoma of the esophago-gastric junction.
METHODS: A total of 350 patients who were pathologically diagnosed with Siewert type Ⅱ or type Ⅲ adenocarcinoma of the esophago-gastric junction and underwent surgical treatment at our hospital were included, of whom 148 received surgery via the transthoracic approach (transthoracic group) and 202 received surgery via transabdominal hiatal approach (transabdominal hiatal group). Intraoperative parameters, postoperative recovery and complications were compared between the two groups of patients.
RESULTS: The number of patients receiving multi-visceral resection was more in the transabdominal hiatal group than in the transthoracic group (χ2 = 12.744, P = 0.002), but the operative time, intraoperative blood loss, length of esophageal resection and number of patients receiving transfusion were lower in the transabdominal hiatal group (P = 0.039, 0.011, 0.009, 0.000). Postoperative pain score and antibiotic use duration in the transthoracic group were significantly higher than those in the transabdominal hiatal group (t = 5.879, 9.388, P = 0.005, 0.000), and the length of hospital stay, postoperative hospitalization cost, reoperation, and readmission rate showed the same trend (P = 0.027, 0.021, 0.048, 0.025). Although the rates of abdominal cavity infection and anastomotic stenosis showed no statistical differences between the two groups (χ2 = 1.524, 0.149, P = 0.217, 0.700), the rates of lung infection, postoperative bleeding and anastomotic leakage were significantly higher in the transthoracic group than in the transabdominal hiatal group (χ2 = 9.031, 9.031, 4.215, P = 0.003, 0.040, 0.024).
CONCLUSION: Patients with type Ⅱ or Ⅲ adenocarcinoma of the esophago-gastric junction treated via the transabdominal hiatal approach suffered from less intraoperative trauma and had quicker recovery and lower incidence of complications.
Collapse
|
10
|
Okholm C, Svendsen LB, Achiam MP. Status and prognosis of lymph node metastasis in patients with cardia cancer - a systematic review. Surg Oncol 2014; 23:140-6. [PMID: 24953457 DOI: 10.1016/j.suronc.2014.06.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 05/09/2014] [Accepted: 06/01/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Adenocarcinoma of the gastroesophageal junction (GEJ) has a poor prognosis and survival rates significantly decreases if lymph node metastasis is present. An extensive lymphadenectomy may increase chances of cure, but may also lead to further postoperative morbidity and mortality. Therefore, the optimal treatment of cardia cancer remains controversial. A systematic review of English publications dealing with adenocarcinoma of the cardia was conducted to elucidate patterns of nodal spread and prognostic implications. METHODS A systematic literature search based on PRISMA guidelines identifying relevant studies describing lymph node metastasis and the associated prognosis. Lymph node stations were classified according to the Japanese Gastric Cancer Association guidelines. RESULTS The highest incidence of metastasis is seen in the nearest regional lymph nodes, station no. 1-3 and additionally in no. 7, 9 and 11. Correspondingly the best survival is seen when metastasis remain in the most locoregional nodes and survival equally tends to decrease as the metastasis become more distant. Furthermore, the presence of lymph node metastasis significantly correlates to the TNM-stage. Incidences of metastasis in mediastinal lymph nodes are associated with poor survival. CONCLUSION The best survival rates is seen when lymph node metastasis remains locoregional and survival rates decreases when distant lymph node metastasis is present. The dissection of locoregional lymph nodes offers significantly therapeutic benefit, but larger and prospective studies are needed to evaluate the effect of dissecting distant and mediastinal lymph nodes.
Collapse
Affiliation(s)
- Cecilie Okholm
- Department of Surgical Gastroenterology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 København Ø, Denmark.
| | - Lars Bo Svendsen
- Department of Surgical Gastroenterology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Michael P Achiam
- Department of Surgical Gastroenterology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 København Ø, Denmark
| |
Collapse
|
11
|
Gu J, Wang YS, Wang M, Li YM, Wang YJ. Treatment of gastric cardia cancer with capecitabine and oxaliplatin: an analysis of 46 cases. Shijie Huaren Xiaohua Zazhi 2008; 16:3443-3447. [DOI: 10.11569/wcjd.v16.i30.3443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate efficacy of capecitabine in combination with oxaliplatin in treating advanced gastric cardia cancer.
METHODS: Forty-six patients with histologically or cytologically confirmed advanced gastric cardia cancer were retrospectively analyzed. Eastern Cooperative Oncology Group performance statuses of 0, 1 and 2 were 11, 21 and 14 cases, respectively. All had adequate organ function. All of the patients were prescribed oxaliplatin 130 mg/m2 intravenously on day 1 and capecitabine 1000 mg/m2 orally twice a day, on days 1-14 of a 21-day cycle. The response rate (RR), time to progression (TTP) and overall survival (OS) of patients were analyzed.
RESULTS: The tumor response rate was 45.7% (95% CI: 39.1% to 60.9%), including 4 cases of complete response (8.7%)and 17 cases of partial response (37.0%), respectively. Mean time to tumor progression was 9 months (95% CI: 5.2-12.8), and average survival time was 15 months (95% CI: 7.6-22.4). To date, there had been 34 deaths all irrelevant to chemotherapy. Notable grade 3 events from the entire cohort included nausea/vomiting (2 patients), diarrhea (2 patients), peripheral sensory neuropathy (2 patients), hand and foot syndrome (2 patients) and neutropenia (2 patients).
CONCLUSION: First-line treatment of oxaliplatin in combination with capecitabine for advanced adenocarcinoma of the esophagus, gastroesophageal junction and for gastric cardia cancer is effective. This regimen yields an acceptable toxicity profile and merits further study.
Collapse
|
12
|
Abstract
AIM: Genetic polymorphisms of drug-metabolizing enzymes have recently been shown to affect susceptibility to chemical carcinogenesis. Cytochrome P450 2E1 (CYP2E1) enzyme catalyzes the metabolism of many procarcinogens, such as N-nitrosamines and related compounds. The gene coding for this enzyme is polymorphic and thus may play a role in gastric cardia cancer (GCC) etiology. In this hospital-based case-control study, we evaluate the relationship between genetic polymorphisms of CYP2E1 and the risk of GCC.
METHODS: The study subjects comprised 159 histologically confirmed GCC cases identified via hospital cancer registry and surgical records at five hospitals in Fuzhou, Fujian Province, China, between April and November 2001. Controls were 192 patients admitted to the same hospitals for nonmalignant conditions. The genotypes of CYP2E1 were detected by a PCR-based RFLP assay. The odds ratios were estimated by logistic regression analyses and were adjusted for potential confounding factors.
RESULTS: The distribution of three genotypes of CYP2E1 in GCC cases and controls was significantly different (χ2 = 16.04, P<0.01). The frequency of the CYP2E1 (c1/c1) genotype in GCC cases and controls was 60.4% and 40.1%, respectively. The CYP2E1 (c1/c1) genotype was associated with an increased risk for GCC (the adjusted (OR) was 2.37, 95% confidence interval (CI): 1.52-3.70). Subjects who carried the CYP2E1 (c1/c1) genotype and were habitual smokers were at a significantly higher risk of developing GCC (OR = 4.68, 95%CI: 2.19-10.04) compared with those who had the CYP2E1 (c1/c2 or c2/c2) genotype and did not smoke.
CONCLUSION: These results suggest that the CYP2E1 genotype may influence individual susceptibility to development of GCC, and that the risk increases significantly in smokers.
Collapse
Affiliation(s)
- Lin Cai
- Department of Epidemiology, UCLA School of Public Health, 71-225 CHS, Box 951772, 10833 Le Conte Avenue, Los Angeles, CA 90095-1772, USA.
| | | | | |
Collapse
|