61 THE 5-YEAR RESULTS FOR ENDOSCOPIC TREATMENT OF SUPERFICIAL ESOPHAGEAL CANCER AT A NORWEGIAN UNIVERSITY HOSPITAL

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
T Hauge ◽  
T Hauge ◽  
M Franco-Lie ◽  
E Johnson
Keyword(s):  
Esophageal Cancer ◽  
Treatment Modality ◽  
Endoscopic Treatment ◽  
University Hospital ◽  
Low Grade ◽  
Superficial Esophageal Cancer ◽  
Radical Esophagectomy ◽  
Efficient Treatment ◽  
First Choice

Abstract   Superficial esophageal cancer (HGD = high grade dysplasia, T1a and T1b with no evidence of spread) accounts for about 20 % of all esophageal cancers. Traditionally, radical esophagectomy, with a significant degree of comorbidity has been the mainstay of treatment. Now most international guidelines, including the ESGE (European Society of Gastrointestinal Endoscopy) recommends endoscopic treatment as the first choice of treatment. The aim of this abstract was to present our data from 2014-2018. Methods From 2014 to 2018 (and ongoing) we have registered all patients endoscopically treated for LGD (low grade dysplasia) and superficial esophageal cancer, including some cases with T1b. The patient material, including treatment modality, histology, time of follow-up, the need for surgery and its outcome were registered. The majority of follow-ups took place at our hospital. Data was also retrieved from cases of late follow-up at other hospitals. Results 86 patients were endoscopically treated. The histology revealed LGD (24%), HGD (50%) and adenocarcinoma (21%). 15% were treated for a T1a tumor, 7% for T1b. 29% underwent endoscopic mucosal resection (EMR), 29% radiofrequency ablation (RFA) and 40% had both. The endoscopic treatment resulted in complete resolution of dysplasia in 64%, downstaging in 11%, whilst progression occurred in 11%. Five patients were operated for initial T1b or progression into T1b. The operation specimen showed no residual tumor in 3/5 patients. There were no serious complications. 90-days mortality was 1%. Conclusion Endoscopic treatment is a safe and efficient treatment option for superficial esophageal cancer. Few patients needed surgery and there was few and exclusively mild complications. This treatment modality will spare many patients for esophageal surgery with its associated high level of comorbidity.

146 LEVEL OF DYSPHAGIA AND QUALITY OF LIFE FOLLOWING ENDOSCOPIC TREATMENT OF LOW-GRADE DYSPLASIA AND SUPERFICIAL ESOPHAGEAL CANCER

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
T Hauge ◽  
T Hauge ◽  
M Franco-Lie ◽  
C Amdal ◽  
E Johnson
Keyword(s):  
Quality Of Life ◽  
Esophageal Cancer ◽  
Reference Population ◽  
Low Grade ◽  
Emotional Status ◽  
Superficial Esophageal Cancer ◽  
Low Grade Dysplasia ◽  
Lower Hrqol

Abstract   Low-grade dysplasia (LGD) and superficial esophageal cancer (high grade dysplasia, T1a and superficial T1b) can be endoscopically treated according to most international guidelines, including the European Society of Gastrointestinal Endoscopy from 2017. The aim was to assess the level of dysphagia and health-related quality of life (HRQOL) in patients who underwent endoscopic treatment. Methods From 2014–2018 all patients with LGD and superficial esophageal cancer were included. The patients underwent endoscopic mucosal resection (EMR) and/or radiofrequency ablation (RFA). In June 2019 the patients were contacted per mail for assessment of the level of dysphagia and HRQOL, using the Ogilvie score and the European Organisation for Research and Treatment of Cancer (EORTC) core-questionnaire QLQ-C30 together with the disease-specific module QLQ-OG25. Results 59 out of the 86 patients alive (69%) completed the questionnaires after a median follow-up of 28 months (8–65 months). 24% of the patients answering the questionnaires underwent EMR, 31% RFA and 44% both EMR and RFA. There was no significant difference (p > 0.05) regarding the level of dysphagia, weight loss, global QoL and emotional status, neither with respect to a non-cancerous reference population nor between the treatment groups. For the other variables in QLQ-C30 and QLQ-OG25, the patients experienced significant lower HRQOL. 12% had minor problems eating solid food (Ogilvie score 1), of whom all underwent EMR. Conclusion The majority of patients endoscopically treated for LGD and superficial esophageal cancer experienced no dysphagia after a median follow-up of 28 months. The patients experienced significant lower HRQOL when being compared to an age-matched non-cancerous reference population. There was no difference regarding the level of dysphagia, weight loss, global QoL and emotional status.

scholarly journals Warshaw Technique in Laparoscopic Spleen-Preserving Distal Pancreatectomy: Surgical Strategy and Late Outcomes of Splenic Preservation

2019 ◽  
Vol 2019 ◽  
pp. 1-10
Author(s):  
Lei Wang ◽  
Dong Wu ◽  
Yu-gang Cheng ◽  
Jian-wei Xu ◽  
Hai-bo Chu ◽  
...  
Keyword(s):  
Distal Pancreatectomy ◽  
Splenic Abscess ◽  
Healthy Population ◽  
Low Grade ◽  
Efficient Treatment ◽  
Spleen Preserving ◽  
Significant Difference ◽  
Splenic Vessels

Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) can be accomplished with either the preservation or the resection of splenic vessels; the latter is also known as Warshaw technique. Our study is designed to investigate the operation selection strategy when proceeding LSPDP and to evaluate the long-term outcomes of patients undergoing Warshaw surgery. The medical records and follow-up data of patients who underwent LSPDP in Qilu Hospital, Shandong University, were reviewed retrospectively. A total of thirty-five patients were involved in this study, including 17 cases of patients who were treated with Warshaw procedure (WT) while the other 18 cases had splenic vessels preserved (SVP). Compared with the SVP group, the operative time and intraoperative blood loss in WT group were improved significantly. The incidence of early postoperative splenic infarction was higher in WT group. However, there was no report of splenic abscess or second operation. Follow-up data confirmed that there was no significant difference in spleen phagocytosis and immune function compared with normal healthy population. Our study confirms that LSPDP-Warshaw procedure is a safe and efficient treatment for the benign or low grade malignant tumors in distal pancreas in selected patients. The long-term spleen function is normal after Warshaw procedure. Preoperative assessment and intraoperative exploration are recommended for the selection of operation approaches.

scholarly journals Outcome after endoscopic treatment for dysplasia and superficial esophageal cancer – a cohort study

2020 ◽  
Vol 55 (9) ◽  
pp. 1132-1138
Author(s):  
Tobias Hauge ◽  
Isabel Franco-Lie ◽  
Else Marit Løberg ◽  
Truls Hauge ◽  
Egil Johnson
Keyword(s):  
Esophageal Cancer ◽  
Cohort Study ◽  
Endoscopic Treatment ◽  
Superficial Esophageal Cancer

Efficacy of Yttrium-90 Zevalin Outside of Clinical Trials: Preliminary Results of a Retrospective Bi-Center Study

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5015-5015
Author(s):  
Francesco Cicone ◽  
Francesco Scopinaro ◽  
Sebastien Baechler ◽  
Nicolas Ketterer ◽  
Franz Buchegger ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Clinical Setting ◽  
Patient Population ◽  
Statistical Significance ◽  
University Hospital ◽  
Low Grade ◽  
Number Of Patients ◽  
Significant Difference ◽  
Routine Clinical Setting

Abstract Background and Aim: Due to limited data regarding the efficacy of Radioimmunotherapy with 90Y-Zevalin (RIT-Z) outside of controlled clinical trials, we carried out a biinstitutional, international retrospective study to assess the efficacy of RIT-Z in a routine clinical setting. The relationship between the number of previous therapies and outcomes as well as the response to the last therapy was assessed. Possible differences in outcomes for patients treated in the two different centers were also analyzed. Materials and Methods: Forty-three consecutive patients treated at the University Hospital of Lausanne (CHUV, Switzerland) and at S. Andrea University Hospital of Rome (Italy) were evaluated, none of which had been previously included in clinical trials. Only 31 patients entered the final analysis: patients lost at follow up, undergoing autologous transplantation (ASCT), or treated within the last 3 months were excluded. Efficacy of therapy was evaluated in terms of Overall Survival (OS), Progression Free Survival (PFS), and Time to Next Treatment (TTNT). Survival curves were obtained with the Kaplan- Meier method (statistical significance = p<0.05). Results: Characteristics of the patient population are listed in Table 1. Although 50% of the patients had aggressive histologies, patients treated at S. Andrea had slightly more favorable features than those treated at CHUV. Fourteen patients (45%) had received at least 4 previous treatments, and all had received Rituximab. Fourteen patients (45%) had not responded to the last therapy, while 6 (19%), all treated at S.Andrea, were considered disease-free at the time of RIT-Z, which was administered for consolidation. Median follow up time was 20 months (11.5 vs. 25 months for S.Andrea and CHUV, respectively). Median PFS and TTNT were similar. After achieving a partial response, 2 patients were referred to Rituximab maintenance after RIT-Z and remain progression-free. Median OS was still not attained. Although not statistically significant, a trend towards better outcomes for S. Andrea patients was found. In comparing patients with indolent and aggressive lymphoma, only PFS was found to be significantly different (median PFS: 10 vs. 5 months, p<0.05). In patients with <4 and ≥ 4 previous therapies, twenty month OS was 88% vs. 53.6% (p=0.02), respectively; median TTNT was 22 vs. 5 months (p=0.013), while differences in PFS did not attain statistical significance. The duration of response in non-responders to their last therapy was shorter than in responders: 20-month OS- 44% vs. 94% (p=0.0015), median PFS and TTNT- 3.5 vs. 15 months (p=0.0002) and 4 vs. 15 months (p=0.0001), respectively. Median PFS and TTNT after RIT-Z did not differ from those found after the last therapy. A significant difference in outcomes for heavily pretreated or refractory patients was found in those with low grade follicular lymphoma. Conclusions: Poorer outcomes were found in our patient population treated in a routine clinical setting compared to those enrolled in clinical trials. This may be related to greater heterogeneity of our study cohort which included more patients with unfavorable conditions (e.g. aggressive NHL, ≥4 treatment courses including rituximab in all, and ASCT in 25%). Our results suggest that the best benefit may be expected with RIT-Z either for consolidation or relatively earlier in the course of NHL treatment. Table 1. Total CHUV S. Andrea Population Analyzed (72%) Number of patients 43 23 20 31 Median Age 61 63 58,5 62 Aggressive Histology (FL grade 3 or DLBCL) 18 (41,8%) 8 (34,7%) 10 (50%) 11 (35,5%) Indolent Histology (FL grade 1 or 2) (%) 25 (58,2%) 15 (65,3%) 10 (50%) 20 (64,5%) Patients with ≥4 previous treatments 19 (44,2%) 12 (52,1%) 7 (35%) 14 (45,2%) Patients with previous ASCT 11 (25,6%) 6 (26%) 5 (25%) 8 (25%)

scholarly journals Management of Bilaterally Impacted Labial and Palatal Maxillary Canines With One-Year Follow-Up: A Case Report

2020 ◽  
pp. 030157422096530
Author(s):  
Sarvraj S Kohli ◽  
Virinder Singh Kohli
Keyword(s):  
Case Report ◽  
Female Patient ◽  
Treatment Modality ◽  
Efficient Treatment ◽  
Impacted Canines ◽  
Ideal Position ◽  
End Of Treatment ◽  
One Year ◽  
Smile Aesthetics

Introduction: Management of impacted maxillary canines is considered to be complex and challenging task by orthodontists due to the varied biomechanical considerations involved. Objective: This article describes an effective and efficient treatment modality for de-impaction of bilaterally impacted labial and palatal canines. Case Report: A female patient aged 13 years and 5 months presented with the following complaints: absence of tooth numbers 13 and 23, crowding in the upper and lower anterior dental units, and over-retained tooth numbers 53 and 63 with a non-consonant smile arc. Results: Arch development was done to create space for tooth numbers 13 and 23, as well as to relieve crowding. The impacted canines were surgically exposed, and guided traction was employed to place them in their ideal position. A class I canine and premolar relation was established. The smile aesthetics were also improved. The result remained stable 12 months after the end of treatment. The improvement can be quantified by the reduction in scores of orthodontic indices measured pretreatment and posttreatment. Conclusion: Modifications in continuous arch mechanics can be reliably used in the management of impacted canines and arch development.

scholarly journals Combined endoscopic treatment in the patient with inoperable middle third esophageal cancer (4-year clinical follow-up)

2015 ◽  
Vol 4 (4) ◽  
pp. 27-30
Author(s):  
E. V. Filonenko ◽  
A. N. Urlova ◽  
N. N. Volchenko
Keyword(s):  
Esophageal Cancer ◽  
Endoscopic Treatment

Optimum Treatment Strategy for Superficial Esophageal Cancer: Endoscopic Mucosal Resection versus Radical Esophagectomy

2001 ◽  
Vol 25 (4) ◽  
pp. 424-431 ◽  
Author(s):  
Hiromasa Fujita ◽  
Susumu Sueyoshi ◽  
Hideaki Yamana ◽  
Koji Shinozaki ◽  
Uhi Toh ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Endoscopic Mucosal Resection ◽  
Treatment Strategy ◽  
Superficial Esophageal Cancer ◽  
Radical Esophagectomy ◽  
Optimum Treatment ◽  
Mucosal Resection ◽  
Optimum Treatment Strategy

scholarly journals Prophylactic colectomy and rectal preservation in FAP: systematic endoscopic follow-up and adenoma destruction changes natural history of polyposis

2021 ◽  
Vol 09 (07) ◽  
pp. E1014-E1022
Author(s):  
Arnaud Pasquer ◽  
Nicolas Benech ◽  
Mathieu Pioche ◽  
Antoine Breton ◽  
Jerome Rivory ◽  
...  
Keyword(s):  
Endoscopic Treatment ◽  
Total Colectomy ◽  
Ileoanal Anastomosis ◽  
University Hospital ◽  
Prophylactic Surgery ◽  
Safe Alternative ◽  
Oncological Safety ◽  
History Of ◽  
Surgical Guidelines

Abstract Background and study aims Prophylactic surgery of familial adenomatous polyposis (FAP) includes total colectomy with ileorectal anastomosis (IRA) to proctocolectomy with ileoanal anastomosis (IAA). Surgical guidelines rely on studies without systematic endoscopic follow-up and treatment. Our aim was to report our experience based on a different approach: therapeutic follow-up, comparing in this setting IRA and IAA in terms of oncological safety and quality of life. Patients and methods Between January 1965 and November 2015, all patients who underwent prophylactic surgery for FAP with therapeutic endoscopic follow-up in Lyon University hospital: systematic endoscopic treatment of adenomas, were retrospectively and prospectively (since 2011) included. Results A total of 296 patients were analyzed: 92 had proctocolectomy with IAA (31.1 %), 197 total colectomy with IRA (66.5 %), and seven abdominoperineal resections (2.4 %). Median follow-up was 17.1 years (range, 0–38.1). Incidence of secondary cancer (IR vs. IAA) was 6.1 % vs. 1.1 % (P = 0.06; 95 %CI 0.001–0.36). The 15-year cancer-free and overall survival (IR vs. IAA) were 99.5 % vs 100 % (P = 0.09) and 98.9 % vs. 98.8 % (P = 0.82), respectively. Postoperative morbidity occurred in 44 patients: 29 (14.7 %) in the IRA and 15 (16.3 %) in the IAA group (P = 0.72). The mean number of stools per day in the respective groups were 4.4 (2.5) vs. 5.5 (2.6) (P = 0.001). Fecal incontinence occurred in 14 patients (7.1 %) in the IRA vs. 16 (17.4 %) in the IAA group (P = 0.03). Conclusions A combination of therapeutic endoscopic treatment and extended rectal preservation appears to be a safe alternative to ileoanal J-pouch anastomosis.

scholarly journals Usefulness of E7 mRNA in HPV16-positive women to predict the risk of progression to HSIL/CIN2+

2021 ◽  
Author(s):  
Cristina Marti ◽  
Lorena Marimon ◽  
Ariel Glickman ◽  
Carla Henere ◽  
Adela Saco ◽  
...  
Keyword(s):  
Mrna Expression ◽  
Pap Smear ◽  
Histological Diagnosis ◽  
University Hospital ◽  
Low Grade ◽  
Hpv Testing ◽  
Increased Risk ◽  
Risk Of Progression ◽  
Hpv16 Infection

Objective: To evaluate whether E7 mRNA can predict the risk of progression in women with HPV16 infection. Design: prospective observational study Setting: Tertiary university hospital Population: A cohort of 139 women referred to colposcopy for an abnormal screening result fulfilling the following inclusion criteria: 1) a positive test result confirming HPV16 infection; 2) a biopsy sample with a histological diagnosis of absence of lesion or low-grade SIL/CIN grade1 (LSIL/CIN1); 3) no previous HPV vaccination; 4) no pregnancy; and 5) no previous cervical treatments; and 6) no immunosuppression. Methods: At the first visit all women underwent a cervical sample for liquid-based cytology, HPV testing and genotyping, and HPV16 E7 mRNA analysis and a colposcopy with at least one colposcopy-guided biopsy. Follow-up visits were scheduled every six months. In each control a liquid-based Pap smear, HPV testing, as well as a colposcopy examination with biopsy if necessary were performed. Main outocome measures: Histological diagnosis of HSIL/CIN2+ at any time during follow-up Results: E7 mRNA expression was positive in 55/127 (43.3%) women included in the study and seven (12.7%) progressed to HSIL/CIN2+. In contrast, only 1/72 (1.4%) women with no HPV16 E7 mRNA expression progressed (p=0.027). HPV16 E7 mRNA expression was associated with a 10-fold increased risk of progression (HR 10.0; 95%CI 1.2-81.4). Conclusions: HPV16 E7 mRNA could be useful for risk stratification of women with HPV16 infection in whom a HSIL/CIN2+ has been ruled out.

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