[Cancer of the Esophagogastric Junction: Double Tract Reconstruction - Evidence and Technique]. / Adenokarzinome des ösophagogastralen Überganges: Double-Tract-Rekonstruktion ­ Evidenz und Technik.

Adenocarcinoma of the esophagogastric junction (AEG) still represent a certain surgical challenge. In contrary to the trend of thoracoabdominal surgery for AEG I and AEG II cancer, the proximal gastrectomy is regaining popularity through new reconstruction methods such as the double tract reconstruction. Proximal gastrectomy followed by double tract reconstruction represents an alternative for the thoracoabdominal approach for suitable AEG II cancer and an alternative to the total gastrectomy for AEG III cancers. Latest studies suggest a functional benefit of proximal gastrectomy and double tract reconstruction in comparison to total gastrectomy. The accurate indication for proximal gastrectomy for locally advanced cancers has to be established in the near future as well as the influence of the size of the remnant stomach on the outcome, as Asian techniques for early lesions sometimes significantly differ from European. The following article reflects the present evidence on proximal gastrectomy and double tract reconstruction as well as technical aspects in the context of cancer of the esophagogastric junction.

[Minimally Invasive Esophagectomy for Esophageal Cancer]. / Minimalinvasive Ösophagektomie für maligne Tumore der Speiseröhre.

Minimally Invasive Esophagectomy for Esophageal Cancer Abstract. Oncological esophagectomy with gastric pull up and intrathoracic represents the standard surgical procedure in the curative treatment of malignant tumors of the esophagus and the esophagogastric junction. The procedure, as two or three body cavities are accessed, has a natural level of invasiveness, which suggests lowering the surgical trauma using minimally invasive surgery (MIS). Because of the complexity of the surgical procedure, minimally invasive esophagectomy is an operation with relevant surgical learning curve. As of now, two principally different minimally invasive techniques for esophageal resection are established in clinical routine in specialized centers, the conventional laparoscopy/thoracoscopy based method and the robotic approach. Benefits of minimally invasive esophagectomy are reduced pulmonary complications and reduced postoperative pain. The surgical radicality of both minimally invasive techniques is at least comparable to the open approach and combined MIS/open approach, long-term survival outcomes from randomized controlled trials are pending. The robotic surgical technology has evolved dramatically over the last decade and oncological esophagectomy offers meaningful opportunity for application. Due to further technological progress, robotic surgery is expected to play an even more important role in the future. Focusing on the direct comparison of conventional minimally invasive esophagectomy and robotic-assisted esophagectomy, the randomized ROBOT-2 trial will reveal important evidence.

[Endoscopic Interventional Treatment of Precancerous Lesions and Early Carcinoma of the Esophagus - Criteria and Techniques of Local Ablation and Resection]. / Endoskopisch interventionelle Behandlung von Malignitätsvorstufen und des Frühkarzinomes des Ösophagus.

Endoscopic Interventional Treatment of Precancerous Lesions and Early Carcinoma of the Esophagus - Criteria and Techniques of Local Ablation and Resection Abstract. Early carcinomas of the esophagus can safely be resected endoscopically and interventionally under very strict conditions (ER). In contrast to ablative procedures (radiofrequency ablation, cryo-ablation, argon plasma coagulation, photodynamic therapy), which can only be recommended for Barrett's or low-grade dysplasia, ER - which is called EMR (endoscopic mucosal resection in adenocarcinoma) or more in-depth ESD (endoscopic submucosa dissection in squamous cell carcinoma) - a defined, histologically examinable preparation. This is required starting with high-grade dysplasia, since 50% of patients with biopsy-confirmed high-grade dysplasia after ER already have an invasive carcinoma in the specimen. This diagnostic gap is thus also closed with an interventional ER. ER is therefore an option for high-grade dysplasia in Barrett's, carcinoma in situ (Cis) and conditionally in T1a (adeno- and squamous cell carcinoma) and early T1b tumors (adenocarcinoma).

[Modern Multimodal Concepts for Advanced and Metastatic Esophageal Cancer]. / Moderne multimodale Konzepte für fortgeschrittene und metastasierte Ösophaguskarzinome.

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.

[Chemotherapy and Radio-Chemotherapy of Locally Advanced Esophageal Cancer]. / Chemotherapie und Radio-/Chemotherapie des lokal fortgeschrittenen Ösophaguskarzinoms.

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.

[Diagnosis and Treatment of Gastroesophageal Reflux Disease in Childhood]. / Diagnostik und Therapie der gastroösophagealen Reflux-Krankheit im Kindesalter.

Diagnosis and Treatment of Gastroesophageal Reflux Disease in Childhood Abstract. In children with gastroesophageal reflux disease (GERD), conservative and surgical therapy options should be weighed up against each other and an individual solution tailored to the pediatric patient should be found. Decision should be made by an interdisciplinary team with representatives of all treating and caring disciplines together with the patient and his or her caregivers. The possibility of a surgical intervention and (if needed) the optimal time to operate should hereby be discussed with a (pediatric) surgeon at an early stage. Contrary to the possible fears of conservative disciplines, fundoplication for targeted surgical GERD therapy in childhood is usually carried out with few complications and, in well-defined cases, is associated with a positive outcome. The fulfillment of the decisive prerequisites for this is closely linked to the knowledge of the pediatric characteristics with regard to symptoms, diagnosis and therapy, the choice of the optimal surgical technique and a long-term secured follow-up care. The key points of these pediatric features are explained in detail below.

[Does the Oral Microbiome Influence Carcinogenic Changes of the Esophagus? - A Systematic Review]. / Beeinflusst das orale Mikrobiom kanzerogene Veränderungen des Ösophagus?

Does the Oral Microbiome Influence Carcinogenic Changes of the Esophagus? - A Systematic Review Abstract. The oral microbiome plays a crucial role in maintaining a physiological oral and esophageal environment, but possibly also in the development and progression of diseases, such as esophageal cancer. However, the underlying mechanism for this correlation is not understood. Esophageal carcinomas harbor a high malignancy and show a high incidence - worldwide they are the sixth most common cause of carcinoma-related death. The aim of this review was to find out to what extent the oral microbiome can be used as a marker for early detection of esophageal cancer. A systematic literature search was performed in the Pubmed®, Livivo® and Cochrane Library® databases. A total of eight studies were included in the review. These showed a correlation between oral dysbiosis and increased esophageal cancer risk, i.e., increased (i.e., genera Prevotella, Porphyromonas, Streptococcus) or decreased (i.e., genera Haemophilus, Neisseria) relative abundances of various bacteria were associated with higher risk. However, the results of the studies were very heterogeneous. A correlation between carcinogenic changes of the esophagus and changes in the oral microbiome is evident. However, further studies are needed to clarify the possible causal role of the oral microbiota in carcinogenesis.

[Peracute Diseases of the Esophagus - Bleeding from Esophageal Varices, Esophageal Varices]. / Perakute Erkrankungen des Ösophagus.

Peracute Diseases of the Esophagus - Bleeding from Esophageal Varices, Esophageal Varices Abstract. Due to a permanently increased portal venous pressure - usually due to infectious or ethyltoxic liver cirrhosis - varices can form in the lower esophagus due to expansion of the submucosal venous plexus. Acute bleeding from the esophageal varices is a life-threatening situation. In therapy, a distinction is made between primary prophylaxis of bleeding, control of acute bleeding and prevention of recurrent bleeding. In addition to non-selective betablockers, the transjugular intrahepatic portosystemic shunt (TIPS), which is introduced radiologically, plays a decisive role today, especially in the prophylaxis of recurrent bleeding. Apart from special indications, surgical shunt procedures are only of historical value. In liver cirrhosis patients, liver transplantation represents a causal treatment and lasting cure for esophageal varices.

[Achalasia Update]. / Update Achalasie.

Achalasia Update Abstract. The neurodegenerative disease achalasia (obsolete: "cardiac spasm") is the second most common functional disease of the esophagus after reflux disease. It is associated with an extremely high level of suffering for the patient. Pathophysiologically, it is a combination of a lack of swallowing-reflex relaxation at the gastric entrance and disturbed peristalsis of the tubular esophagus. The gold standard in diagnostics is high-resolution manometry. The disease cannot be cured, the therapeutic spectrum that alleviates the disease includes pharmaceutical, endoscopic-interventional and surgical procedures.

[Complications and Management of Complications After Resection and Reconstruction of the Esophagus]. / Komplikationen und Komplikationsmanagement nach Resektion und Rekonstruktion der Speiseröhre.

Complications and Management of Complications After Resection and Reconstruction of the Esophagus Abstract. A curative therapy of advanced esophagus carcinoma is primarily made possible by radical esophagectomy with lymphadenectomy. Impressive advances in the surgical techniques of esophageal surgery through minimally invasive and robotic oesophagectomy have been made in the last two decades. The perioperative management with prehabilitation, PDK application, early mobilization and early food intake also contributed significantly to a reduction in complications. However, esophageal surgery is fraught with complications. Anastomotic leakage is the most common technical-surgical complication. The rate is approximately 10-16%, independent of the technique and procedure. In addition to an experienced, subtle, atraumatic and rapid surgical technique, early detection (clinical, endoscopic, radiological) and adequate, interdisciplinary management of perioperative complications in resecting esophageal surgery are the key to increasing the safety of these complex interventions. The treatment of the complications includes conservative, interventional and surgical measures. In the last few decades, there has been a radical change from once exclusively surgical revisions with a high degree of invasiveness and a poor outcome to today's mostly conservative-interventional management with little patient burden and - in centers with the appropriate expertise - good results.

[Curative Treatment of Esophageal Carcinoma - Disease, Diagnostics, Therapy in 2022]. / Kurative Therapie des Ösophaguskarzinomes.

Curative Treatment of Esophageal Carcinoma - Disease, Diagnostics, Therapy in 2022 Abstract. Surgical resection remains the gold standard for non-metastatic carcinoma of the lower and middle third of the esophagus. Locally advanced tumors (T3) are pretreated neoadjuvantly (radiochemotherapy) or perioperatively (chemotherapy). A differentiated primary staging and an interdisciplinary case presentation are of essential importance today. The individual risk assessment, the pre-habilitation and the individualized treatment play a major role. Clinically, the further advancement of access minimization - through laparoscopic/thoracoscopic and robot-assisted procedures and the associated reduction of access trauma - as well as the treatment of this entity in high volume centers are clearly in the foreground. For cervical carcinomas definitive radiotherapy is often the better alternative, both for tumor biological reasons and for reasons of the increase in complications during surgery.

[Results of pancreatic surgery from the perspective of patients: a cross-sectional study of the support group "Arbeitskreis der Pankreatektomierten e. V."] / Ergebnisse nach Pankreaseingriffen aus Sicht der Betroffenen: Versorgungsforschung der Selbsthilfegruppe "Arbeitskreis der Pankreatektomierten e. V.".

BACKGROUND: The support group "Arbeitskreis der Pankreatektomierten e. V. (AdP)" was founded in 1976 and is the largest group of individuals affected by pancreatic disease in Germany. Members of the AdP support patients with pancreatic disease. This patient-initiated, cross-sectional study intends to present the results of pancreatic surgery from the perspective of patients. METHODS: Since March the 3 rd, 2018, members of the AdP received a questionnaire with eleven categories of questions concerning their medical history. This data was gathered in a medical database and analysed. RESULTS: 625 members were operated upon, with 57.5 % receiving pancreaticoduodenectomy, 15.5 % distal pancreatectomy, 23.2 % total pancreatectomy, and 4.0 % another or unknown operation. 37.9 % were diagnosed with pancreatic cancer, 38.2 % with another type of pancreatic tumour, 25 % with pancreatitis, 4 % with autoimmune pancreatitis and 2.7 % with other rare entities.82 patients of 237 pancreatic cancer patients survived more than 5 years. 24.5 % of the 237 patients reported have a second primary malignancy and 13.9 % have close family members with pancreatic cancer.Weight loss after pancreatic surgery was dependant on the type of operation with the greatest after pancreatectomy (17.8 ±â€Š9.5 kg). The prevalence of diabetes was 54.1 %, the incidence of new onset perioperative diabetes 33.3 %. 91.5 % needed pancreatic enzyme replacement therapy, on average 189 417 IE/day. The reported quality of life was independent from type of surgery received. CONCLUSION: Following complex pancreatic surgery, patients are confronted with daily lifelong challenges. AdP members offering their shared experiences offer meaningful support to newly affected patients. Individuals affected by pancreatic disease could be an important but underutilised resource to studying these diseases.

Glucose transporters 1, 3, 6, and 10 are expressed in gastric cancer and glucose transporter 3 is associated with UICC stage and survival.

BACKGROUND: Due to proliferation and increased metabolism, cancer cells have high glucose requirements. The glucose uptake of cells is influenced by a group of membrane proteins denoted the glucose transporter family (Glut-1 to -12). Whereas increased expression and a negative correlation with survival have been described for Glut-1 in several types of cancer, the impact of other glucose transporters on tumor biology is widely unknown. METHODS: In this retrospective study, gastric cancer specimens of 150 patients who underwent total gastrectomy between 2005 and 2010 were stained for Glut-1, -3, -6, and -10 by immunohistochemistry. Expression of Glut-1, -3, -6, and 10 was correlated to prognosis as well as clinical and pathological parameters. RESULTS: Glut-1, Glut-3, Glut-6, and Glut-10 were expressed in 22.0, 66.0, 38.0, and 43.3 % of the analyzed samples. Whereas Glut-1, -6, and -10 did not show a correlation with prognosis, positive staining for Glut-3 was associated with higher UICC stage and inferior prognosis. The mean overall survival was 38.6 months for Glut-3 positive patients, as compared to 51.2 months for Glut-3 negative patients (p < 0.05). Coexpression of two or more of the analyzed glucose transporters was correlated to inferior prognosis. Glut-3 and UICC stage were significant prognostic factors in multivariate analysis. CONCLUSIONS: All of the analyzed glucose transporters were expressed in a significant proportion of the gastric cancer samples. Glut-3 was associated with higher UICC stage and inferior prognosis. These findings are relevant to therapeutic approaches that target glucose metabolism as well as to imaging using radioactively labeled glucose.

Third international conference of the European Union Network of Excellence on gastric and esophagogastric junction cancer, Cologne, Germany, June 2012.

In 2012 the European Union Network of Excellence on gastric and esophagogastric junction cancer (EUNE) held its third conference in Cologne, Germany. The main themes discussed included translational research, standard and audit, early diagnosis, development of surgical treatment, adequate surgery for EGJ cancer, adjuvant and neoadjuvant treatment, prevention of peritoneal carcinomatosis and finally education and training. The meeting was attended by 150 experts from 18 different countries.

Regional lymphadenectomy strongly recommended in T1b gallbladder cancer.

This article discusses the adequate treatment of early gallbladder cancer (T1a, T1b) and is based on published studies extending over nearly 3 decades. Randomized studies and meta analyses comparing different surgical treatments do not exist. The literature shows that in up to 20% of patients lymph node metastasis are found in T1b gallbladder cancer. Due to high malignancy with early angiolymphatic spread and resistance to chemotherapy and radiation on the one hand, and the relative low operative risk of extended cholecystectomy (cholecystectomy and regional lymphadenectomy) on the other hand, we believe that this procedure is mandatory in early gallbladder cancer.