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1.
Anticancer Res ; 40(4): 2275-2281, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234926

RESUMO

BACKGROUND/AIM: To assess the prognostic effect of muscle loss after esophagectomy and before discharge. PATIENTS AND METHODS: This study retrospectively analysed 159 consecutive patients with oesophageal and gastroesophageal junction cancer who underwent esophagectomy between August 2011 and October 2015. Body composition was evaluated one week before surgery and at discharge using a bioelectrical impedance analyser. RESULTS: The median rate of muscle mass loss (RMML) was 4.38% (range=-3.3 to +18.8). Patients with increased RMML had significantly poorer outcomes of overall survival than those with decreased RMML (p=0.015). On multivariate analysis, RMML [≥4.38, hazard ratio (HR)=2.033, 95% confidence interval (CI)=1.018-5.924, p=0.044) and pathological tumour depth (≥2, HR=3.099, 95%CI=1.339-7.172, p=0.008) were selected as independent prognostic factors. CONCLUSION: RMML after esophagectomy is indicative of poor prognosis in patients with esophageal cancer.


Assuntos
Neoplasias Esofágicas/fisiopatologia , Esofagectomia/métodos , Junção Esofagogástrica/fisiopatologia , Transtornos Musculares Atróficos/fisiopatologia , Neoplasias Gástricas/fisiopatologia , Idoso , Intervalo Livre de Doença , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Junção Esofagogástrica/patologia , Junção Esofagogástrica/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Transtornos Musculares Atróficos/etiologia , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia
2.
DNA Cell Biol ; 39(5): 828-835, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32181690

RESUMO

Increasing evidence suggested that long noncoding RNAs (lncRNAs) variants may be involved in the progression of various cancers. However, the association of the lncRNAs polymorphisms with the risk for esophagogastric junction adenocarcinoma (EGJA) is still unknown. In this case-control study, we selected two cancer-related lncRNAs polymorphisms (rs944289 C > T and rs7990916 C>T), and recruited a total of 1063 EGJA patients and 1677 noncancer controls to determine whether the lncRNAs rs944289 C > T and rs7990916 C > T polymorphisms could influence EGJA susceptibility and lymph node status. And SNPscan™ genotyping assay was applied to test the genotypes of the mentioned two variants. We found no statistically significant differences in the distribution of lncRNAs rs944289 C > T and rs7990916 C > T polymorphisms between EGJA patients and healthy controls. Similar negative findings were also revealed in the correlation of those polymorphisms with different lymph node status. However, after adjustment by multiple environmental factors, including gender, age, drinking, and smoking consumption, the stratified analyses showed that the lncRNAs rs944289 C > T variant was significantly related with the risk of EGJA in <60 years populations [CT vs. CC: adjusted odds ratio (OR) = 0.75, 95% confidence interval (CI) = 0.58-0.98, p = 0.032] and ever smoking populations (CT/CC vs. TT: adjusted OR = 1.65, 95% CI = 1.11-2.46, p = 0.013). In short, this population-based study highlights that lncRNAs rs944289 C > T polymorphism may be associated with genetic susceptibility to EGJA in the <60 years and ever smoking populations.


Assuntos
Adenocarcinoma/genética , Neoplasias Esofágicas/genética , Junção Esofagogástrica/patologia , Predisposição Genética para Doença/genética , Polimorfismo Genético , RNA Longo não Codificante/genética , Adenocarcinoma/patologia , Estudos de Casos e Controles , Neoplasias Esofágicas/patologia , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade
3.
Medicine (Baltimore) ; 99(7): e18332, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049776

RESUMO

BACKGROUND: Patients with advanced gastric or gastro-oesophageal junction cancer (GC/GEJC) that fail to respond to prior chemotherapy have poor clinical prognosis. Lately, many trials have paid much attention on the oncological outcomes of immune checkpoint inhibitors (ICI). A new therapy based on programmed death 1 (PD-1)/programmed death ligand 1 (PD-L1) inhibitors has recognized as promising prospects for advanced GC/GEJC. We assessed efficacy and safety of PD-L1 antibody versus chemotherapy alone in previously treated non-small cell lung cancer. METHODS: Computerized literature search was done on the published trials in: Pubmed, Embase, Cochrane library updated on June 2019. Randomized controlled trials were selected investigating chemotherapy plus PD-1/PD-L1 versus chemotherapy alone. RESULTS: Three randomized controlled trails were included. The pooled analysis of overall survival (OS) was longer with anti-PD1/PD-L1 than with chemotherapy alone in the OS (OR = 0.66, 95%CI = 0.47-0.92, P = .02) and sub-group OS of GEJC (OR = 0.73, 95%CI = 0.58-0.93, P = .01). Whereas, there is no significant difference in progression-free survival (OR = 0.93, 95%CI = 0.62-1.39, P = .72). The pooling adverse events (AE) data did not achieve advantage in the PD-1/PD-L1 targeted agents (OR = 0.53, 95%CI = 0.13-2.10, P = .36), the same as the treatment-related AE of grade 3 to 5 (OR = 0.53, 95%CI = 0.16-1.74, P = .30). CONCLUSIONS: Treatment of patients with advanced GC/GEJC with PD-1/PD-L1 targeted did result in an improvement in some but not all survival endpoints. Moreover, it had a comparable toxicity profile as compared with chemotherapy alone. More well designed studies are needed to develop a database of all anti-PD1/PD-L1 sub-groups and their individual impact on the differing anti-PD1/PD-L1 treatments.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Neoplasias Esofágicas/tratamento farmacológico , Junção Esofagogástrica/patologia , Neoplasias Gástricas/tratamento farmacológico , Anticorpos Monoclonais Humanizados/efeitos adversos , Antígeno B7-H1/antagonistas & inibidores , Humanos , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Ensaios Clínicos Controlados Aleatórios como Assunto , Análise de Sobrevida , Resultado do Tratamento
4.
J Surg Oncol ; 121(6): 1015-1021, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32090338

RESUMO

BACKGROUND AND OBJECTIVES: Current data are conflicting as to whether the outcomes of octogenarians undergoing resection for esophagogastric adenocarcinoma are comparable to younger patients. This study aims to compare perioperative outcomes and survival of patients ≥80 years old with younger patients undergoing curative resection for esophagogastric adenocarcinoma. METHODS: Retrospective data were collected on 190 patients who underwent resection with curative intent for adenocarcinomas found in the stomach and esophagogastric junction from 2004 to 2015 at a single institution. RESULTS: Of the 190 patients, 34 (18%) were ≥80 years old. Octogenarians were more likely to have chronic kidney disease (CKD) and were less likely to have received neoadjuvant chemotherapy. Pathologic features were similar between groups. Octogenarians' tumors were more likely to be located in the gastric body as compared to the esophagogastric junction in younger patients. Although the length of stay was comparable, octogenarians were significantly less likely to be discharged home (P < .01). Both groups had a single death during the index admission. Incidence and severity of 90 days postoperative complications were not significantly different between groups. There was no difference in 30-day, 90-day, 1-year, or median survival. CONCLUSIONS: Perioperative outcomes and survival of octogenarians undergoing curative resection for esophagogastric cancer are comparable to younger patients at our institution.


Assuntos
Neoplasias Esofágicas/cirurgia , Junção Esofagogástrica/cirurgia , Neoplasias Gástricas/cirurgia , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Neoplasias Esofágicas/patologia , Junção Esofagogástrica/patologia , Feminino , Humanos , Masculino , Período Perioperatório , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Taxa de Sobrevida , Resultado do Tratamento
5.
Anticancer Res ; 40(2): 965-975, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32014941

RESUMO

BACKGROUND/AIM: A standard treatment recommendation for advanced stage gastroesophageal cancer is still missing. PATIENTS AND METHODS: We retrospectively analyzed clinical data of patients with inoperable locally advanced or metastatic gastroesophageal cancer treated between 2001 and 2017 at the Vienna General Hospital, Austria. RESULTS: Administration of systemic therapy was positively associated with overall survival (OS) (469 days vs. 185 days; p<0.001), while palliative gastrectomy or radiotherapy showed no correlation. OS was significantly longer in patients receiving capecitabine/oxaliplatin (XELOX) vs. leucovorin/5-FU/oxaliplatin (FOLFOX) (600 days vs. 327 days, p<0.05). Comparison of doublet vs. triplet chemotherapies showed no difference in OS, but triplet chemotherapy resulted in more adverse events. The anti-HER2-antibody trastuzumab doubled OS (836 days vs. 399 days, p=0.053). CONCLUSION: Capecitabine may be preferably used over infused 5-FU and doublet chemotherapy over triplet chemotherapy in the first-line palliative setting of advanced gastroesophageal cancer.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/patologia , Junção Esofagogástrica/patologia , Cuidados Paliativos , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias Esofágicas/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Cuidados Paliativos/métodos , Neoplasias Gástricas/mortalidade , Resultado do Tratamento
6.
Mymensingh Med J ; 29(1): 195-201, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915358

RESUMO

Gastric cancer (GC) is one of the most common tumors and remains the second leading cause of cancer mortality in the world. The incidence of gastric carcinoma is declining in the last few years in some areas like USA, UK, Canada etc, because of reduction in chronic H. pylori infection, smoking, decrease use of smoked and salted food. The gastric carcinoma still remains a burden for Bangladesh as the prevalence of H. Pylori has not substantially decreases. Among the gastric carcinomas, adenocarcinomas are the most common type. So the study was performed to observe the location and histomorphologic pattern of Gastric and gastrooesophageal junction (GEJ) adenocarcinoma. This descriptive cross sectional study was carried out at the Department of Pathology, Dhaka Medical College, Dhaka, Bangladesh from January 2013 to December 2014. A total of 130 patients with primary gastric and GEJ adenocarcinomas were included in this study. All the cases were evaluated for routine histological examination. The age range of the patients was 17 to 80 years and male to female ratio was 2.25:1. Antrum is the most common (66.9%) site being affected, followed by GEJ (19.2%), body (13%) and fundus (0.76%). Tumors of the antrum and GEJ were found mostly in the late age. On macroscopic examination, the ulcerated tumor mass (69.2%) was most frequent then the others. Regarding histological examination, 84(64.6%) cases were intestinal type, 32(24.6%) diffuse and 14(10.8%) mixed type by Laurens classification. According to WHO classification, about half of the cases (49.2%) were tubular carcinoma and rest were others. Most of the intestinal type carcinoma (71.4%) was presented with moderately differentiated and 25.0% with well differentiated. Where as the diffuse type presented with poorly differentiated in 96.9% cases.


Assuntos
Adenocarcinoma/patologia , Junção Esofagogástrica/patologia , Neoplasias Gástricas/patologia , Adenocarcinoma/classificação , Adenocarcinoma/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bangladesh/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Gástricas/epidemiologia , Adulto Jovem
7.
Nat Commun ; 11(1): 84, 2020 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-31901081

RESUMO

Areas of a junction between two types of epithelia are known to be cancer-prone in many organ systems. However, mechanisms for preferential malignant transformation at the junction areas remain insufficiently elucidated. Here we report that inactivation of tumor suppressor genes Trp53 and Rb1 in the gastric squamous-columnar junction (SCJ) epithelium results in preferential formation of metastatic poorly differentiated neoplasms, which are similar to human gastroesophageal carcinoma. Unlike transformation-resistant antral cells, SCJ cells contain a highly proliferative pool of immature Lgr5-CD44+ cells, which are prone to transformation in organoid assays, comprise early dysplastic lesions, and constitute up to 30% of all neoplastic cells. CD44 ligand osteopontin (OPN) is preferentially expressed in and promotes organoid formation ability and transformation of the SCJ glandular epithelium. OPN and CD44 overexpression correlate with the worst prognosis of human gastroesophageal carcinoma. Thus, detection and selective targeting of the active OPN-CD44 pathway may have direct clinical relevance.


Assuntos
Carcinoma de Células Escamosas/metabolismo , Junção Esofagogástrica/metabolismo , Receptores de Hialuronatos/metabolismo , Osteopontina/metabolismo , Receptores Acoplados a Proteínas-G/metabolismo , Neoplasias Gástricas/metabolismo , Idoso , Idoso de 80 Anos ou mais , Animais , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Transformação Celular Neoplásica , Estudos de Coortes , Junção Esofagogástrica/patologia , Feminino , Humanos , Receptores de Hialuronatos/genética , Masculino , Camundongos , Camundongos Knockout , Pessoa de Meia-Idade , Osteopontina/genética , Receptores Acoplados a Proteínas-G/genética , Proteína do Retinoblastoma/genética , Proteína do Retinoblastoma/metabolismo , Neoplasias Gástricas/genética , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Proteína Supressora de Tumor p53/genética , Proteína Supressora de Tumor p53/metabolismo
8.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(1): 20-25, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-31958926

RESUMO

Adenocarcinoma of esophagogastric junction (AEG) has a special anatomical position. In clinical practice, there are many overplays among thoracic surgeons, gastrointestinal surgeons, gastroenterologists and oncologists. In recent years, AEG has attracted more and more clinical attention with its increasing incidence. It has a tendency to be gradually separated from esophageal cancer and gastric cancer and be defined as a new special type of tumor. At present, there are still many controversies in the definition, classification, TNM staging, surgical approach, extent of resection, lymph node dissection, digestive tract reconstruction and neoadjuvant therapy of AEG. Meanwhile many problems still need to be solved, which is in a stage of gradual improvement and standardization. This article mainly reviews the important research progress in the field of AEG in 2019, summarizes the current clinical hotspots of AEG, especially the surgical treatment hotspots and the current application status of related new technologies, and aims the future development. We suggest that communication and cooperation among multiple disciplines should be strengthened. Through more clinical researches, basic experimental researches, and innovation and application of new technologies, personalized and accurate diagnosis and treatment will be carried out for patients with different conditions to ultimately achieve the common goal of maximizing the benefits of patients.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias Esofágicas/cirurgia , Junção Esofagogástrica/cirurgia , Neoplasias Gástricas/cirurgia , Adenocarcinoma/classificação , Adenocarcinoma/diagnóstico , Adenocarcinoma/patologia , Neoplasias Esofágicas/classificação , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/patologia , Junção Esofagogástrica/patologia , Humanos , Excisão de Linfonodo/tendências , Estadiamento de Neoplasias , Neoplasias Gástricas/classificação , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologia
9.
J Surg Res ; 246: 292-299, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31630013

RESUMO

BACKGROUND: Laparoscopic proximal gastrectomy (LPG) with double-tract reconstruction (DTR) is performed as a function-preserving surgery for patients with adenocarcinoma of esophagogastric junction. However, whether LPG with DTR has postoperative advantages over laparoscopic total gastrectomy (LTG) is debatable. To evaluate benefits of LPG with DTR, we compared short-term surgical outcomes between LPG with DTR and LTG for adenocarcinoma of esophagogastric junction (AEG). METHODS: Twelve patients who underwent LPG with DTR for AEG between February 2016 and August 2017 were included. Twenty-four patients who underwent LTG in the same period were matched to LPG with DTR cases for demographics, comorbidities, tumor characteristics, and tumor node metastasis stage. Short-term surgical outcomes were compared between the two groups. RESULTS: Demographics of the LPG with DTR group and LTG group were comparable. The number of harvested lymph nodes in the LPG with DTR group was less than that in the LTG group, and the amount of estimated blood loss, the operative time, the days of gas-passing, start of diet, postoperative hospital stay were not significantly different between the groups. Furthermore, the postoperative reflux symptom in the LPG with DTR group was not significantly different with that in the LTG group. However, the increasing percentages of the serum albumin, total protein, and hemoglobin levels in the LPG with DTR group were significantly higher than those in the LTG group. CONCLUSIONS: This study reveals that LPG with DTR may be a valuable procedure for the treatment of AEG because it has the advantages over LTG in terms of postoperative serum albumin, total protein, and hemoglobin.


Assuntos
Adenocarcinoma/cirurgia , Gastrectomia/efeitos adversos , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/sangue , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Neoplasias Gástricas/cirurgia , Adenocarcinoma/patologia , Junção Esofagogástrica/patologia , Junção Esofagogástrica/cirurgia , Feminino , Gastrectomia/métodos , Hemoglobinas/análise , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Albumina Sérica Humana/análise , Neoplasias Gástricas/patologia , Fatores de Tempo , Resultado do Tratamento
10.
Clin Nucl Med ; 45(1): 38-43, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31714278

RESUMO

PURPOSE: The outcome of locally advanced adenocarcinoma of the esophagogastric junction (AEG) treated with preoperative chemoradiotherapy is heterogeneous, and favorable response to this treatment is a key factor in the patient's prognosis. The aim of this study was to evaluate F-FDG PET/CT in assessing metabolic response in patients with AEG. MATERIALS AND METHODS: This prospective study evaluated all consecutive patients with potentially operable locally advanced AEG who were candidates for neoadjuvant chemoradiotherapy. PET/CT and contrast-enhanced thoracoabdominal CT were performed at baseline and 2 weeks after completion of chemoradiotherapy for response evaluation. The response rate was assessed using Response Evaluation Criteria in Solid Tumors criteria for contrast-enhanced thoracoabdominal CT and Positron Emission Tomography Response Criteria in Solid Tumors criteria for PET/CT. The regression rate was assessed using a 5-grade histopathology scoring system of the surgically resected tumor. Metastatic lesions were confirmed by histopathology examination or imaging and clinical follow-up at 6 months. RESULTS: A total of 40 cases were finally included in the study. Distant metastases were found in the baseline PET/CT in 6 of 40 cases (retroperitoneal [2] or mediastinal/hiliar [1] lymph nodes and liver [2] or bone [1] metastases) and were therefore excluded from surgery. Pathologic response correlated with the ΛSUVmax threshold of ≤45% (P = 0.033). CT response correlated well with both the baseline SUVmax (P = 0.039) and the ΛSUVmax (P = 0.001). Five-year survival curves for AEG correlated with the ΛSUVmax using a threshold of ≤45% for both progression-free and overall survival. CONCLUSIONS: F-FDG PET/CT is useful for diagnosing nonsuspected metastasis before neoadjuvancy in potentially operable AEG. The ΛSUV correlates with pathologic response and is a long-term independent prognostic factor of survival.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/terapia , Quimiorradioterapia , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/terapia , Junção Esofagogástrica/patologia , Fluordesoxiglucose F18 , Terapia Neoadjuvante , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Adenocarcinoma/patologia , Neoplasias Esofágicas/patologia , Junção Esofagogástrica/diagnóstico por imagem , Junção Esofagogástrica/efeitos dos fármacos , Junção Esofagogástrica/efeitos da radiação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos
11.
BMJ Case Rep ; 12(10)2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31604716

RESUMO

Leptomeningeal carcinomatosis (LC) is rare in solid tumours, particularly in gastrointestinal cancers. While other treatment strategies remain undefined, inclusion of palliative care is essential due to its very poor prognosis and variable manifestations. We report a case of oesophagogastric junction adenocarcinoma, previously submitted to surgery and chemotherapy, diagnosed with LC and followed in a palliative care unit. Treatment was comanaged with the oncology team and a palliative approach was decided. In this report, we review the literature and evaluate treatment options, with focus on the importance of palliative care and its potential benefits in patients diagnosed with this rare entity.


Assuntos
Neoplasias Esofágicas/terapia , Junção Esofagogástrica/patologia , Carcinomatose Meníngea/terapia , Cuidados Paliativos , Neoplasias Gástricas/terapia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade
12.
Zhonghua Bing Li Xue Za Zhi ; 48(10): 767-771, 2019 Oct 08.
Artigo em Chinês | MEDLINE | ID: mdl-31594040

RESUMO

Objective: To investigate the clinicopathological characteristics of gastric mixed adenoneuroendocrine carcinoma (MANEC). Methods: The clinical and pathologic data of 36 cases of gastric MANEC collected from January 2011 to December 2018 in the Department of Pathology, Fujian Provincial Hospital were retrospectively analyzed. Light microscopy and EnVision immunohistochemical (IHC) staining were used in the study. The results were compared with 40 cases of gastric neuroendocrine carcinoma collected within the same period. Results: The 36 cases were collected, there were 29 males and 7 females. The patients' age ranged from 43 to 87 years (mean 66 years). The tumor diameter ranged from 1.0 to 9.0 cm (mean 5.0 cm). Clinical staging showed that four cases were at T1+T2 stages and 32 cases were at T3+T4 stages. The main clinical manifestations were upper abdominal pain, abdominal distension and dysphagia. Complete follow-up data were obtained in 20 (eleven living and nine dead) patients. Pathologic analysis showed that all tumors were composed of neuroendocrine carcinoma and adenocarcinoma and each of the components was more than 30%. IHC staining showed that CK was expressed in adenocarcinoma; whereas the neuroendocrine carcinoma mainly expressed CD56 and Syn. There was no significant difference in age, sex, T stage and prognosis between gastric MANEC and gastric neuroendocrine carcinoma(P>0.05). Gastric neuroendocrine carcinoma predominantly occurred in the esophagogastric junction and the gastric body but only rarely in the gastric antrum; gastric MANEC mainly occurred in the esophagogastric junction and the gastric antrum but rarely in the gastric body. Gastric MANEC was more prone to lymph node metastasis than gastric neuroendocrine cancer(P<0.05). Conclusions: Most of the gastric MANEC patients are middle-aged and elderly males, and the tumors predominantly occur in the esophagogastric junction and the gastric antrum. Most of the patients are found to have higher stages, and most of them have lymph node metastases and poor prognosis.


Assuntos
Adenocarcinoma/patologia , Carcinoma Neuroendócrino/patologia , Neoplasias Gástricas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Junção Esofagogástrica/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(10): 932-936, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31630489

RESUMO

In recent years, the incidence of adenocarcinoma of esophagogastric junction (AEG) keeps increasing. Siewert type II and type III AEG invades at 2-4 cm in the lower esophagus, and it has a higher rate of lower mediastinal lymph node metastasis. Lower mediastinal lymph node clearing through the abdomino-transhiatal (TH) approach is preferred, which can be accomplished by entering the lower mediastinum through the hiatus and mobilize the esophagus upward and the surrounding lymph and connective tissue for approximately 6.5 cm. Using the infracardiac bursa (IBC) as an anatomical landmark improves the safety and operability of the thorough dissection of the lower mediastinum. Total resection of the mesenterium at the esophagogastric junction can entirely dissect the lower mediastinal lymph nodes, which conforms to the safety principles in oncology.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias Esofágicas/cirurgia , Junção Esofagogástrica/cirurgia , Excisão de Linfonodo/métodos , Mesentério/cirurgia , Adenocarcinoma/patologia , Neoplasias Esofágicas/patologia , Junção Esofagogástrica/patologia , Humanos , Mediastino/patologia , Mediastino/cirurgia , Mesentério/patologia
14.
BMC Surg ; 19(1): 152, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651313

RESUMO

BACKGROUND: The number of patients with esophagogastric junction (EGJ) cancers has tended to increase. However, no clear consensus on the optimum treatment policy has yet been reached. METHODS: This study included patients diagnosed with adenocarcinoma of Sievert type II in whom resection was performed in our hospital. We performed a clinicopathological examination, and patients were divided into two groups by the tumor size: L group, tumor size ≥4 cm; and S group, tumor size < 4 cm. The clinical factors, such as nodal dissection and recurrence pattern, were then analyzed. RESULTS: A total of 48 patients were diagnosed with ECJ cancers. The average tumor size was 55.1 mm, and 32 cases (66.7%) had tumors ≥4 cm. Metastasis to the mediastinum was noted in 4 cases (12.5%) in the L group but none in the S group. Recurrence in the upper or middle mediastinum lymph nodes was noted in 3 cases (9.4%) in the L group. The 5-year overall survival rates were 49.7 and 83.9% in the L and S groups, respectively. CONCLUSIONS: As the tumor grows large, it is difficult to accurately judge EGJ on the image, and as a result it is difficult to understand the exact esophageal invasion distance of the tumor. Therefore, lymph node dissection including the upper mediastinum is considered vital, regardless of the degree of esophageal invasion.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias Esofágicas/cirurgia , Junção Esofagogástrica/patologia , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Excisão de Linfonodo/métodos , Linfonodos/patologia , Metástase Linfática , Masculino , Mediastino/patologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Retrospectivos , Taxa de Sobrevida
15.
Cir. Esp. (Ed. impr.) ; 97(8): 427-431, oct. 2019. graf
Artigo em Espanhol | IBECS | ID: ibc-187615

RESUMO

La estadificación clínica preoperatoria es crítica para seleccionar aquellos pacientes cuya enfermedad está localizada y se podrá beneficiar de una cirugía con intención curativa. Idealmente, dicha estadificación debería predecir la invasión tumoral, la afectación linfática y las metástasis a distancia. Con el cTNM podemos seleccionar aquellos pacientes a los que podremos ofrecer una resección endoscópica, una cirugía radical o evitarla en aquellos con metástasis a distancia. Para el diagnóstico inicial de los adenocarcinomas de la unión esofagogástrica se requiere una endoscopia con biopsias. Para la estadificación clínica: TC toracoabdominopélvico, ultrasonografía endoscópica y la PET o la PET-TC. Otras exploraciones de utilidad son: tránsito baritado, resección endoscópica de la mucosa o disección endoscópica de la submucosa (para valoración de estadios iniciales) y la laparoscopia de estadificación. Una vez establecida la resecabilidad del tumor deberá valorarse la operabilidad del mismo en función del estado del paciente


Preoperative clinical staging is critical to select those patients whose disease is localized and may benefit from surgery with curative intent. Ideally, such staging should predict tumor invasion, lymphatic involvement and distant metastases. With the cTNM, we are able to select patients who could benefit from endoscopic resection, radical surgery or less radical treatment in patients with distant metastasis. The initial diagnosis of adenocarcinomas of the esophagogastric junction requires endoscopy with biopsies. For clinical staging, thoracoabdominal-pelvic CT scan, endoscopic ultrasound and PET or PET/CT are used. Other useful explorations are: barium swallow, endoscopic mucosal resection or endoscopic submucosal dissection (for assessment in initial stages) and staging laparoscopy. Once the resectability of the tumor has been established, the operability of the tumor should be assessed according to the patient's condition


Assuntos
Humanos , Adenocarcinoma/patologia , Neoplasias Esofágicas/patologia , Junção Esofagogástrica/patologia , Estadiamento de Neoplasias/métodos , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/cirurgia , Enema Opaco/métodos , Biópsia , Meios de Contraste/administração & dosagem , Endoscopia do Sistema Digestório , Endossonografia , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/cirurgia , Tomografia Computadorizada por Raios X , Cuidados Pré-Operatórios/métodos , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons
16.
Cir. Esp. (Ed. impr.) ; 97(8): 432-437, oct. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-187616

RESUMO

La nueva 8.ª edición del sistema de clasificación TNM para el cáncer de esófago y cardias, o de la unión esofagogástrica, aporta importantes novedades en la confección de los estadios TNM. Se presentan 2 clasificaciones actualizadas por estadios, clínicos (cTNM) y patológicos (pTNM), junto a otra clasificación patológica aplicable a los casos que reciben tratamiento neoadyuvante (ypTNM). Hay un notable aumento de la complejidad con respecto a versiones anteriores, pero aún es pronto para conocer si las actuales modificaciones redundarán, como es su objetivo principal, en una manifiesta mejora de la discriminación pronóstica de la supervivencia entre los grupos de pacientes que configuran, si bien las expectativas iniciales son favorable


The new 8th edition of the TNM classification system for esophageal and cardia or esophagogastric junction cancer provides important innovations in the TNM stages. Two classifications are presented, updated by stages, clinical (cTNM) and pathological (pTNM) methods, together with another pathological classification applicable to cases receiving neoadjuvant treatment (ypTNM). There is a notable increase in complexity compared to previous versions, but it is still early to determine whether the current modifications will result in a clear improvement in the prognostic discrimination of survival among the patient groups (which is their main objective), although the initial expectations are favorable


Assuntos
Humanos , Adenocarcinoma/patologia , Neoplasias Esofágicas/patologia , Junção Esofagogástrica/patologia , Estadiamento de Neoplasias/métodos , Reprodutibilidade dos Testes , Adenocarcinoma/classificação , Adenocarcinoma/mortalidade , Adenocarcinoma/cirurgia , Calibragem , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/cirurgia , Junção Esofagogástrica/cirurgia , Linfonodos/patologia , Invasividade Neoplásica , Estadiamento de Neoplasias/classificação , Estadiamento de Neoplasias/normas , Estados Unidos
17.
Cir. Esp. (Ed. impr.) ; 97(8): 438-444, oct. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-187617

RESUMO

Los estadios precoces (T1) del cáncer de la unión esofagogástrica continúan representando únicamente el 2-3% de todos ellos. El más frecuente es el adenocarcinoma y el principal factor de riesgo para su desarrollo son el reflujo esofagogástrico y el esófago de Barrett con displasia. Los pacientes con afectación de mucosa (T1a) o de submucosa (T1b) precisan inicialmente de una endoscopia digestiva minuciosa, pudiendo mejorar la visualización con la cromoendoscopia. El tratamiento endoscópico de estas lesiones incluye la mucosectomía, la ablación con radiofrecuencia y la disección endoscópica de la submucosa. El tratamiento óptimo precisa una correcta estadificación y la técnica más adecuada para ello es la ultrasonografía endoscópica. Por otra parte, la sospecha de invasión profunda de la submucosa, la presencia de características anatomopatológicas poco favorables o la imposibilidad de resección endoscópica, obligan a optar por la resección quirúrgica para alcanzar un tratamiento curativo


Early-stage (T1) esophagogastric junction cancer continues to represent 2-3% of all cases. Adenocarcinoma is the most frequent and important type, the main risk factors for which are gastroesophageal reflux and Barrett's esophagus with dysplasia. Patients with mucosal (T1a) or submucosal (T1b) involvement initially require a thorough digestive endoscopy, and narrow-band imaging can improve visualization. Endoscopic treatment of these lesions includes endoscopic mucosal resection, radiofrequency ablation and endoscopic submucosal dissection. Accurate staging is necessary in order to provide optimal treatment. The most precise staging technique in these cases is endoscopic ultrasound. The suspicion of deep invasion of the submucosa, presence of unfavorable anatomopathological characteristics or impossibility to perform endoscopic resection make it necessary to consider surgical resection


Assuntos
Humanos , Adenocarcinoma/cirurgia , Neoplasias Esofágicas/cirurgia , Junção Esofagogástrica/cirurgia , Fatores de Risco , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/etiologia , Adenocarcinoma/patologia , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/etiologia , Neoplasias Esofágicas/patologia , Junção Esofagogástrica/patologia , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Lesões Pré-Cancerosas , Estadiamento de Neoplasias
18.
Cir. Esp. (Ed. impr.) ; 97(8): 445-450, oct. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-187618

RESUMO

Existe una importante controversia en el manejo quirúrgico del cáncer de cardias. Parece unánime que los tumores tipo i de Siewert se intervengan como un cáncer de esófago y los Siewert III como un cáncer gástrico. Sin embargo, sobre el «verdadero» cáncer de cardias o Siewert II no existe consenso. Es obvia la necesidad de un margen proximal y distal libre, así como una correcta linfadenectomía. Para algunos es necesaria la esofaguectomía para realizar una correcta cirugía oncológica radical, pero otros autores defienden que es suficiente con un abordaje abdominal para realizar una gastrectomía total y esofaguectomía distal. Tanto los trabajos publicados con cierta antigüedad como aquellos más recientes no aclaran este dilema y sus resultados son contradictorios. El hecho de realizar un tratamiento quimioterápico previo a la cirugía, puede reducir el tamaño tumoral y la presencia de adenopatías, por lo que las opciones quirúrgicas pueden haber cambiado en los últimos años


There is significant controversy in the management of cardiac cancer. It seems unanimous that Siewert type I tumors be operated on as cancer of the esophagus and Siewert type III as gastric cancer. However, for "true" cancer of the gastric cardia or Siewert II, the authors do not agree. There is the obvious need for free proximal and distal margins, as well as correct lymphadenectomy. For some, esophagectomy is necessary to perform correct radical oncological surgery, but other authors defend that an abdominal approach is sufficient to perform total gastrectomy and distal esophagectomy. Recent and older papers published do not clarify this issue, and their results are contradictory. Chemotherapy prior to surgery can reduce the size of the tumor and the presence of lymphadenopathies


Assuntos
Humanos , Cárdia/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Junção Esofagogástrica/cirurgia , Gastrectomia/métodos , Neoplasias Gástricas/cirurgia , Cárdia/patologia , Neoplasias Esofágicas/classificação , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/patologia , Junção Esofagogástrica/patologia , Neoplasias Gástricas/classificação , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologia , Qualidade de Vida , Carga Tumoral/efeitos dos fármacos
19.
Cir. Esp. (Ed. impr.) ; 97(8): 451-458, oct. 2019. tab, ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-187619

RESUMO

La cirugía mínimamente invasiva permite el tratamiento de los tumores de la unión esofagogástrica en condiciones de seguridad, reduciendo las complicaciones respiratorias y parietales y mejorando la recuperación postoperatoria, manteniendo además los principios de la cirugía oncológica que permitan obtener unos resultados óptimos de efectividad a largo plazo. Para ello, es necesario un volumen de actividad suficiente y avanzar en la curva de aprendizaje de forma tutelada, para poder garantizar una resección R0 y una linfadenectomía adecuada. La mínima invasión no puede ser un objetivo en sí misma. En caso de gastrectomía total, el riesgo de afectación del margen proximal obliga a verificarlo mediante biopsia intraoperatoria, sin descartar la cirugía abierta de entrada. Por su parte, la esofagectomía mínimamente invasiva se ha ido imponiendo progresivamente. Su principal dificultad, la anastomosis intratorácica, puede realizarse mediante una sutura laterolateral mecánica o manualmente asistida por robot, gracias a la visión tridimensional y a la versatilidad del instrumental


Minimally invasive surgery provides for the treatment of esophagogastric junction tumors under safe conditions, reducing respiratory and abdominal wall complications. Recovery is improved, while maintaining the oncological principles of surgery to obtain an optimal long-term outcome. It is important to have a sufficient volume of activity to progress along the learning curve with close expert supervision in order to guarantee R0 resection and adequate lymphadenectomy. Minimal invasiveness ought not become an objective in itself. Should total gastrectomy be performed, the risk of a positive proximal margin makes intraoperative biopsy compulsory, without ruling out a primary open approach. Meanwhile, minimally invasive esophagectomy has been gaining ground. Its main difficulty, the intrathoracic anastomosis, can be safely carried out either with a mechanical side-to-side suture or a robot-assisted manual suture, thanks to the 3-D vision and versatility of the instruments


Assuntos
Humanos , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Junção Esofagogástrica/cirurgia , Gastrectomia/métodos , Procedimentos Cirúrgicos Robóticos , Neoplasias Gástricas/cirurgia , Anastomose Cirúrgica/métodos , Esôfago de Barrett/patologia , Neoplasias Esofágicas/patologia , Junção Esofagogástrica/diagnóstico por imagem , Junção Esofagogástrica/patologia , Esofagoscopia , Laparoscopia , Invasividade Neoplásica , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Complicações Pós-Operatórias/prevenção & controle , Neoplasias Gástricas/patologia
20.
J Surg Oncol ; 120(7): 1142-1147, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31535396

RESUMO

BACKGROUND: The side-to-side anastomosis was considered a promising approach to create an intrathoracic esophagogastrostomy in the minimally invasive esophagectomy, with advantages over the side-to-end anastomosis with aspects of no need for additional mini-thoracotomy and lower occurrence of stenosis. The hand-sewing anterior aspect of the anastomosis is technically challenging in the thoracoscopic Ivor Lewis esophagectomy. Here we introduced our initial experience to facilitate this approach by using the surgical robot and barbed suture. METHODS: A retrospective study of all patients underwent robot-assisted Ivor Lewis esophagectomy with side-to-side esophagogastrostomy from February 2016 to September 2018 was performed. The technical details are described in this paper. RESULTS: A total of 37 patients (35 male and 2 female, median age of 62.7 years) were successfully treated with completely robot-assisted Ivor Lewis esophagectomy. The median total surgical time was 340 minutes including 65 minutes to perform the anastomosis. Median estimated blood loss was 120 mL and the length of hospital stay was 10 days. There was no 90-day mortality. Three patients suffered anastomotic leakage (8.1%,3/37), who were successfully treated without reoperation. CONCLUSION: Our initial results imply that it is technically feasible to perform intrathoracic gastroesophageal anastomosis by taking advantage of a robotic system and knotless suturing.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Junção Esofagogástrica/cirurgia , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Robóticos/métodos , Suturas , Toracoscopia/métodos , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Anastomose Cirúrgica , Carcinoma Neuroendócrino/patologia , Carcinoma Neuroendócrino/cirurgia , Carcinoma de Células Pequenas/patologia , Carcinoma de Células Pequenas/cirurgia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Neoplasias Esofágicas/patologia , Junção Esofagogástrica/patologia , Feminino , Seguimentos , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
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