Evidence in Follow-up and Prognosis of Esophagogastric Junction Cancer

2019 ◽  
Vol 97 (8) ◽  
pp. 465-469
Author(s):  
Lourdes Sanz Álvarez ◽  
Estrella Turienzo Santos ◽  
José Luis Rodicio Miravalles ◽  
María Moreno Gijón ◽  
Sonia Amoza Pais ◽  
...  
Keyword(s):  
Esophagogastric Junction ◽  
Esophagogastric Junction Cancer

scholarly journals Chylous Ascites Accompanying Internal Hernia after Total Gastrectomy with Roux-en-Y Reconstruction

2019 ◽  
Vol 13 (3) ◽  
pp. 481-486
Author(s):  
Ryota Koyama ◽  
Yoshiaki Maeda ◽  
Nozomi Minagawa ◽  
Toshiki Shinohara ◽  
Tomonori Hamada
Keyword(s):  
Internal Hernia ◽  
Esophagogastric Junction ◽  
Intestinal Resection ◽  
Chylous Ascites ◽  
Defect Closure ◽  
Mesenteric Defect ◽  
Esophagogastric Junction Cancer ◽  
History Of ◽  
Reliable Sign

We report the case of a 69-year-old man with a history of esophagogastric junction cancer (Barrett’s esophageal cancer; pT1b [SM], N0, M0, pStage IA) that was surgically resected 2 years prior to the present episode. Recurrence was not observed during follow-up. Following complaints of dysphagia and abdominal pain, computed tomography revealed signs of internal hernia. Thus, laparoscopic exploration was performed. Intraoperatively, accumulation of chylous ascites accompanying the internal hernia through the jejunojejunostomy mesenteric defect was observed, which was successfully treated with laparoscopic hernia reduction and defect closure by sutures without intestinal resection. Here, we discuss the case and report that along with previous studies, our study suggests that chylous ascites might be a reliable sign of intestinal viability for herniated intestines.

scholarly journals Multimodal treatments for resectable esophagogastric junction cancer: a systematic review and network meta-analysis

2019 ◽  
Vol 11 ◽  
pp. 175883591983896 ◽  
Author(s):  
Ji Cheng ◽  
Ming Cai ◽  
Xiaoming Shuai ◽  
Jinbo Gao ◽  
Guobin Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Overall Survival ◽  
Preoperative Chemotherapy ◽  
Esophagogastric Junction ◽  
Meta Analysis ◽  
Preoperative Chemoradiotherapy ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Perioperative Chemotherapy ◽  
Esophagogastric Junction Cancer

Background: Currently, preoperative chemoradiotherapy, perioperative chemotherapy and preoperative chemotherapy are recommended by NCCN, ESMO and Japanese guidelines respectively for resectable esophageal and junctional cancer. However, these recommendations are mainly based on esophageal cancer research. Therefore, specific for esophagogastric junction cancer, we conducted the first systematic review and network meta-analysis to rank all potential treatments simultaneously and hierarchically. Methods: Record retrieval was conducted in PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Embase, ASCO and ESMO Meeting Library from inception to September 2018. Regarding time-to-event survival data, randomized controlled trials featuring comparisons between different multimodal treatments against resectable esophagogastric junction cancer were eligible. Overall survival was the endpoint. Network calculation was based on a random-effects model and the relative ranking of each node was numerically indicated by P-score (CRD42018110369, registration identifier of the meta-analysis in PROSPERO.). Results: Eight studies were included in our systematic review, corresponding to 1218 patients. Regarding overall survival, ‘PreCRT’ (preoperative chemoradiotherapy) topped the hierarchy (HR 1.00, P-score = 0.823), better than ‘PeriCT’ (perioperative chemotherapy; HR 1.32, P-score = 0.591) and ‘PreCT’ (preoperative chemotherapy; HR 1.54, P-score = 0.428). In sensitivity analyses, irrespective of interchanging to fixed-effects model or removing potentially heterogeneous studies, relative rankings remained stable and ‘PreCRT’ was still the optimal node. Conclusion: Preoperative chemoradiotherapy could potentially be the optimal multimodal treatment, which displayed more overall survival benefits than perioperative chemotherapy and preoperative chemotherapy among resectable esophagogastric junction cancer patients. To further verify our pooled results, more randomized trials will be needed to compare preoperative chemoradiotherapy with perioperative chemotherapy (especially FLOT-based regimens).

55 OPTIMAL LYMPH NODE DISSECTION RANGE FOR ESOPHAGOGASTRIC JUNCTION CANCER

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
H Okamoto ◽  
Y Taniyama ◽  
C Sato ◽  
K Takaya ◽  
T Fukutomi ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Esophagogastric Junction ◽  
Mediastinal Lymph Node ◽  
Multidisciplinary Treatment ◽  
R0 Resection ◽  
Preoperative Treatment ◽  
Node Dissection ◽  
Subtotal Esophagectomy ◽  
Esophagogastric Junction Cancer

Abstract   There is no consensus on the mediastinal lymph node dissection range for esophagogastric junction cancer (EGJC). Methods We enrolled 113 patients with EGJC (defined by Nishi’s classification) who underwent R0 resection between January 2001 and December 2016, focusing on comparisons between squamous cell carcinoma (SCC) and adenocarcinoma (AC). Results The characteristics of patients with SCC (n = 53) and AC (n = 55) were as follows: age: 65.4 ± 1.4 and 64.1 ± 1.5 years; male/female: 46/12 and 48/7; preoperative treatment (none/NAC/NACRT): 29/19/10 and 53/2/0; surgical method (subtotal esophagectomy/lower esophagectomy and gastrectomy): 39/19 and 34/21; pStage (I/II/III): 15/14/29 and 13/10/32, respectively. Esophageal invasion (EI) exceeding 20 mm was associated with an increased incidence of metastasis to the upper and middle mediastinal LN in patients with SCC and AC. However, for patients with SCC, the upper/middle mediastinal LN dissection effect index was 6.9/6.9 compared with 0/0 for AC patients. Conclusion In patients with EI exceeding 20 mm, esophagectomy with lymphadenectomy up to the upper mediastinum should be performed owing to the high incidence of upper and middle mediastinal LNM. However, the dissection effect is very poor in patients with AC; therefore, multidisciplinary treatment should be considered for these patients.

PS01.191: LAPAROSCOPIC TRANSHIATAL LOWER MEDIASTINAL LYMPHADENECTOMY FOR ESOPHAGOGASTRIC JUNCTIONAL CANCER: THE INFRACARDIAC BURSA AS A LANDMARK

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 104-104
Author(s):  
Yasunori Kurahashi ◽  
Tatsuro Nakamura ◽  
Rie Ozawa ◽  
Yasutaka Nakanishi ◽  
Hirotaka Niwa ◽  
...  
Keyword(s):  
Lymph Node ◽  
Esophagogastric Junction ◽  
Conflicts Of Interest ◽  
Ventral Side ◽  
Dorsal Side ◽  
Node Dissection ◽  
Mediastinal Lymphadenectomy ◽  
Operating Field ◽  
Esophagogastric Junction Cancer ◽  
The Right

Abstract Background Esophagogastric junction cancer has been increasing recently. As a result, opportunities to perform transhiatal lower mediastinal lymphadenectomy are also increasing. Laparoscopic surgery is useful because the operating field of this site is too deep and narrow to perform laparotomy. But the anatomy of this area is not sufficiently clarified, and since there are few structures as landmarks, it is difficult to set the range and depth of lymph node dissection. Methods We have been verifying anatomically and embryologically the infracardiac bursa (ICB) identified as a closed lumen between the esophagus and the right crus of the diaphragm during an operation. We standardized the procedure of transhiatal lower mediastinal lymphadenectomy setting several landmarks including ICB. Results In transhiatal lower mediastinal lymphadenectomy, it is possible to do a precise lymphadenectomy by setting several landmarks including the ICB and standardizing each procedure on the ventral side, dorsal side, and both sides of the esophagus. In the case of advanced cancer which invades organs around the hiatus, it is difficult to perform routine dissection by using the infracardiac bursa or the dissectable layer. Understanding of the anatomy of this area will support the safe and precise lymphadenectomy. Conclusion In this presentation, we will show the procedure of transhiatal lower mediastinal lymphadenectomy using the ICB as a landmark. Disclosure All authors have declared no conflicts of interest.

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