743 SIEWERT TYPE II GASTRIC CARDIA CANCER: ANALYSIS OF THE RESULTS OF DIFFERENT SURGICAL OPTIONS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Ana Navío-Seller ◽  
David Abelló-Audí ◽  
Mireia Navasquillo-Tamarit ◽  
Milton Emmanuel De Jesús-Acosta ◽  
Marcos Bruna-Esteban ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Locally Advanced ◽  
Surgical Techniques ◽  
Disease Free Survival ◽  
Gastric Cardia ◽  
Distal Margin ◽  
Gastric Cardia Adenocarcinoma ◽  
Type Ii ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy

Abstract   The management of gastric cardia tumors should be carried out from a multidisciplinary approach, there is currently a clear controversy regarding the most appropriate surgical approach to use in type II tumors. Depending on their topographic anatomical characteristics based on the degree of gastric invasion and esophageal, the surgical technique may change: esophagectomy, gastrectomy with distal esophagectomy, or total esophageal gastrectomy. Methods Retrospective and analytical study of patients diagnosed with type II gastric cardia adenocarcinoma (based on the results of the pathological study of the resection specimen) who underwent surgical treatment in our center from June 2012 to June 2020. Different preoperative parameters, the surgical techniques used and the results obtained were analyzed. Results 25 patients were studied, 84% male. 60% were locally advanced tumors with 56% affected nodes. 12 Ivor-Lewis esophagectomies, 5 esophagogastrectomies with coloplasty, and 5 extended total gastrectomies were performed. There was no resection proximal or distal margin involvement, but circumferential margin was affected in 60% of cases of extended gastrectomy and in 1 case of Ivor-Lewis esophagectomy. Median number of lymph nodes removed was 22(5–37) and 2(0–12) affected, being higher in total esophagogastrectomy. Postoperative morbidity was 40% and 90-day mortality 4% (1 case). The mean follow-up was 37 months, noting recurrence in 9 cases (36%), with disease-free survival of 44%. Conclusion The surgical treatment approach in type II gastric tumors is controversial, and there are multiple options to consider. According to the results of this study, the Ivor-Lewis esophagectomy shows to be a safe approach with satisfactory oncological results in tumors that do not require a total esophagogastrectomy.

scholarly journals There is no correlation between a delayed gastric conduit emptying and the occurrence of an anastomotic leakage after Ivor-Lewis esophagectomy

2022 ◽  
Author(s):  
Benjamin Babic ◽  
Lars Mortimer Schiffmann ◽  
Hans Friedrich Fuchs ◽  
Dolores Thea Mueller ◽  
Thomas Schmidt ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
High Volume ◽  
Gastric Conduit ◽  
Common Finding ◽  
Type Ii ◽  
Ivor Lewis ◽  
Stapling Device ◽  
Ivor Lewis Esophagectomy ◽  
Cervical Reconstruction ◽  
Prolonged Hospital

Abstract Introduction Esophagectomy is the gold standard in the surgical therapy of esophageal cancer. It is either performed thoracoabdominal with a intrathoracic anastomosis or in proximal cancers with a three-incision esophagectomy and cervical reconstruction. Delayed gastric conduit emptying (DGCE) is the most common functional postoperative disorder after Ivor-Lewis esophagectomy (IL). Pneumonia is significantly more often in patients with DGCE. It remains unclear if DGCE anastomotic leakage (AL) is associated. Aim of our study is to analyze, if AL is more likely to happen in patients with a DGCE. Patients and methods 816 patients were included. All patients have had an IL due to esophageal/esophagogastric-junction cancer between 2013 and 2018 in our center. Intrathoracic esophagogastric end-to-side anastomosis was performed with a circular stapling device. The collective has been divided in two groups depending on the occurrence of DGCE. The diagnosis DGCE was determined by clinical and radiologic criteria in accordance with current international expert consensus. Results 27.7% of all patients suffered from DGCE postoperatively. Female patients had a significantly higher chance to suffer from DGCE than male patients (34.4% vs. 26.2% vs., p = 0.040). Pneumonia was more common in patients with DGCE (13.7% vs. 8.5%, p = 0.025), furthermore hospitalization was longer in DGCE patients (median 17 days vs. 14d, p < 0.001). There was no difference in the rate of type II anastomotic leakage, (5.8% in both groups DGCE). All patients with ECCG type II AL (n = 47; 5.8%) were treated successfully by endoluminal/endoscopic therapy. The subgroup analysis showed that ASA ≥ III (7.6% vs. 4.4%, p = 0.05) and the histology squamous cell carcinoma (9.8% vs. 4.7%, p = 0.01) were independent risk factors for the occurrence of an AL. Conclusion Our study confirms that DGCE after IL is a common finding in a standardized collective of patients in a high-volume center. This functional disorder is associated with a higher rate of pneumonia and a prolonged hospital stay. Still, there is no association between DGCE and the occurrence of an AL after esophagectomy. The hypothesis, that an DGCE results in a higher pressure on the anastomosis and therefore to an AL in consequence, can be refuted. DGCE is not a pathogenetic factor for an AL.

PS01.158: WHAT IS THE IDEAL RECONSTRUCTIVE TECHNIQUE FOR TYPE 2 GEJ TUMOURS—ESOPHAGOGASTROSTOMY OR ESOPHAGOJEJUNOSTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 94-94
Author(s):  
Servarayan Chandramohan ◽  
Visvarath Varadharajan ◽  
Madeshwaran Chinnathambi ◽  
Kanagavel Manickavasagam ◽  
Abishai Jebaraj ◽  
...  
Keyword(s):  
Blood Loss ◽  
Functional Outcome ◽  
Total Gastrectomy ◽  
Locally Advanced ◽  
Operating Time ◽  
Distal Margin ◽  
Gastric Replacement ◽  
Ivor Lewis ◽  
Significant Difference

Abstract Background In the management of OG junction tumors the border issue arises in type 2 cancers. It can be managed with various options like esophago gastrectomy (Ivor Lewis), transabdominal extended transhiatal gastrectomy or total esophago gastrectomy depends upon the extent strectomy of the tumor above and below. After resection the reconstruction can be either with stomach or jejunum or colon. However the functional result after either of these procedures varies. The aim of this study is to know the functional outcome of different reconstruction methods after esophagogastrectomy for locally advanced Type 2 OG junction tumours. Methods 148 consecutive patients who underwent surgery for OG junction tumors in the last 6 years were evaluated. Of them 62 locally advanced type2 OG junction tumors were included in our study. 26 underwent Ivor Levis procedure with gastric replacement. 36 underwent extended transhiatal gastrectomy with esophago jejunal anastamosis. Intra operative details like pyloroplasty, Operative time, blood loss, the distal margin, nodal clearance was noted. The functional outcome since immediate postoperative period to 1 year of follow up is reviewed retrospectively and prospectively in few cases. Results There is no significant difference in operating time, blood loss. Two patients with Partial gastrectomy had positive distal margin even though it is not statistically significant. The average number of nodes harvested is higher with total gastrectomy group with jejunal anastamosis and it is statistically significant between 2 groups (P < 0.05).The GERD is more with gastric conduit when compared to Jejunal reconstruction but the weight loss is more with jejunal reconstruction when compared with gastric reconstruction. Conclusion The functional outcome and oncological outcome are superior with jejunal reconstruction after total gastrectomy when compared with gastric reconstruction after Ivor Lewis procedure. Disclosure All authors have declared no conflicts of interest.

A retrospective review of treatment outcomes following definitive chemoradiotherapy or single modality radical radiotherapy among patients with locally advanced esophageal cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 196-196
Author(s):  
Ben A Fulton ◽  
Joanna Gray ◽  
Vivienne MacLaren ◽  
David McIntosh ◽  
Alexander McDonald ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Retrospective Analysis ◽  
Oesophageal Cancer ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Radical Radiotherapy ◽  
Tumour Staging ◽  
Definitive Chemoradiotherapy ◽  
Non Surgical Treatment ◽  
Single Modality

196 Background: Definitive chemoradiotherapy (CRT) has been advocated as an alternative to surgical resection for the treatment of locally advanced oesophageal cancer (OC). We have retrospectively reviewed 4 years experience of patients (pts) who underwent contemporary staging and were treated with concurrent chemoradiotherapy (CRT) or single modality radical radiotherapy (RT) with curative intent. Methods: Retrospective analysis permitted identification of consecutive pts who underwent contemporary staging prior to non-surgical treatment for oesophageal carcinoma. The primary outcomes were overall (OS) and disease-free survival (DFS), adjusted for baseline differences in age, tumour staging and histological cell type. All patients were treated with either definitive CRT or single modality RT within a single centre treated between 2009 and 2012. Results: We identified 135 pts in total (median age 69.8 yrs, male=130pts, female=105pts, Adenocarcinoma=85pts, Squamous=150pts). 190 pts received CRT and 45pts were treated with RT. All pts were staged with CT of chest, abdomen and pelvis, 226 pts underwent Endoscopic ultrasound (EUS) and 183 pts had PET-CT. Patients treated with CRT demonstrated longer OS (37 versus 25 months, p=0.02) and DFS (31 versus 16 months, p=0.01) compared to those treated with RT. More advanced tumour stage (stage 3 v stage 1-2) at presentation conferred poorer OS (32 versus 38.2 months) and DFS (11 versus 28 months, p=0.013). We demonstrated an acceptable toxicity profile with only 77 pts (32.8%) and 9 pts (4.2%) experiencing grade III or IV CTC toxicities respectively. Conclusions: This retrospective analysis is in keeping with current treatment paradigms emphasising the importance and safety of concurrent CRT in maximising curative potential for pts undergoing non-surgical treatment of oesophageal cancer. Although retrospective, in comparison to similar retrospective series from our centre, our data suggest improvements in OS and DFS, possibly due to improved patient selection through the use of more effective tumour staging.

scholarly journals Side-to-side esophagogastric anastomosis for minimally invasive Ivor-Lewis esophagectomy: operative technique and short-term outcomes

2021 ◽  
Author(s):  
Manrica Fabbi ◽  
Stefano De Pascale ◽  
Filippo Ascari ◽  
Wanda Luisa Petz ◽  
Uberto Fumagalli Romario
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leak ◽  
Anastomotic Stricture ◽  
Surgical Techniques ◽  
Length Of Hospital Stay ◽  
Pulmonary Complications ◽  
Open Approach ◽  
Short Term ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy

AbstractTotally minimally invasive Ivor-Lewis esophagectomy (TMIIL) is associated to lower rate of post-operative complication, decreases length of hospital stay and improves quality of life compared to open approach. Nevertheless, adaptation of TMIIL still proceeds at slow pace, mainly due to the difficulty to perform the intra-thoracic anastomosis and heterogeneity of surgical techniques. We present our experience with TMIIL utilizing a stapled side-to-side anastomosis. We retrospectively evaluated 36 patients who underwent a planned TMIIL from January 2017 to September 2020. Esophagogastric anastomoses were performed using a 3-cm linear-stapled side-to-side technique. General features, operative techniques, pathology data and short-term outcomes were analyzed. The median operative time was 365 min (ranging from 240 to 480 min) with a median blood loss of 100 ml (50–1000 ml). The median overall length of stay was 13 (7–64) days and in-hospital mortality rate was 2.8%. Two patients (5.6%) had an anastomotic leak, without need for operative intervention and another patient developed an anastomotic stricture, resolved with a single endoscopic dilation. Chylothorax occurred in three patients; two of these required a surgical intervention. Pulmonary complications occurred in six patients (16.7%). Based on Comprehensive Complications Index (CCI), median values of complications were 27.9 (ranging from 20.9 to 100). The results of our study suggest that TMIIL with a 3-cm linear-stapled anastomosis seems to be safe and effective, with low rates of post-operative anastomotic leak and stricture.

Camrelizumab combined with albumin paclitaxel and cisplatin as neoadjuvant therapy for locally advanced esophageal squamous cell carcinoma (ESCC).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16021-e16021
Author(s):  
Huilai Lv ◽  
Yang Tian ◽  
Chao Huang ◽  
Zhenhua Li ◽  
Ziqiang Tian
Keyword(s):  
Surgical Treatment ◽  
Neoadjuvant Therapy ◽  
Clinical Stage ◽  
Objective Response ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Disease Free Survival ◽  
Complete Response ◽  
R0 Resection ◽  
Resection Rate

e16021 Background: The pathologic complete response (pCR) rate is improved by neoadjuvant therapy in locally advanced ESCC, but occurs less than 10% of patients(pts) with neoadjuvant chemotherapy agents. Immunotherapy has become a new promising treatment. Camrelizumab (anti-PD-1) is standard of care as second-line therapy for advanced ESCC in China. Therefore, we intended to evaluate the efficacy and safety of Camrelizumab combined with albumin paclitaxel and cisplatin as neoadjuvant therapy for pts with locally advanced ESCC. Methods: We retrospectively analysed locally advanced ESCC pts with clinical stage Ⅱ-ⅣA. Eligible pts were aged 18–75 years with no prior any therapy. Pts received 2-4 cycles neoadjuvant therapy which including Camrelizumab (200mg IV q3w), albumin paclitaxel (260 mg/m2 IV q3w) and cisplatin (75 mg/m2 IV q3w). Surgery was performed 4-6 weeks after neoadjuvant therapy. The primary endpoint was pCR, the secondary endpoints were major pathologic response (MPR), R0 resection rate, objective response rate (ORR), disease-free survival (DFS) and safety. Results: From Jul 27 2019 to Sep 26 2020,16 pts were enrolled and available evaluated. 8 pts (50%) had clinical complete response (cCR), and the ORR was 87.5% (14/16). All pts underwent surgery and surgical treatment was not delayed. The pCR was 43.8% (7/16), MPR was 75% (12/16). Notably, R0 resection rate was 100% (16/16). None of 16 pts progressed, the DFS was not yet achieved. The average intraoperative blood loss was 131ml (100-200ml) and the average hospitalization time after operation was 14 days (11-21 days). No patient developed anastomotic leak and other surgical treatment-related toxicity. The grade 1-2 treatment-related AEs were reactive cutaneous capillary endothelial proliferation (RCCEP) (n = 3,18.8%), weakness (n = 2, 12.5%), Myelosuppression (n = 1, 6.2%) and hypothyroidism (n = 1, 6.2%). No serious AEs resulted in termination of treatment, and treatment-related death was not observed. Conclusions: The addition of camrelizumab to albumin paclitaxel and carboplatin was demonstrated encouraging clinical efficacy and acceptable safety as neoadjuvant therapy, and might be a favorable option for pts with locally advanced ESCC. Further registered clinical trials are expected.

scholarly journals Short-term outcome of Ivor Lewis esophagectomy following neoadjuvant chemoradiation versus perioperative chemotherapy in patients with locally advanced adenocarcinoma of the esophagus and gastroesophageal junction: a propensity score-matched analysis

2021 ◽  
Author(s):  
Patrick Sven Plum ◽  
Alexander Damanakis ◽  
Lisa Buschmann ◽  
Angela Ernst ◽  
Rabi Raj Datta ◽  
...  
Keyword(s):  
Propensity Score ◽  
Postoperative Morbidity ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiation ◽  
Perioperative Chemotherapy ◽  
Charlson Score ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Gastroesophageal Adenocarcinoma ◽  
Matching Criteria

Abstract Background Patients with locally advanced esophageal or gastroesophageal adenocarcinoma benefit from multimodal therapy concepts including neoadjuvant chemoradiation (nCRT), respectively, perioperative chemotherapy (pCT). However, it remains unclear which treatment is superior concerning postoperative morbidity. Methods In this study, we compared the postsurgical survival (30-day/90-day/1-year mortality) (primary endpoint), treatment response, and surgical complications (secondary endpoints) of patients who either received nCRT (CROSS protocol) or pCT (FLOT protocol) due to esophageal/gastroesophageal adenocarcinoma. Between January 2013 and December 2017, 873 patients underwent Ivor Lewis esophagectomy in our high-volume center. 339 patients received nCRT and 97 underwent pCT. After 1:1 propensity score matching (matching criteria: sex, age, BMI, ASA score, and Charlson score), 97 patients per subgroup were included for analysis. Results After matching, tumor response (ypT/ypN) did not differ significantly between nCRT and pCT (p = 0.118, respectively, p = 0.174). Residual nodal metastasis occurred more often after pCT (p = 0.001). Postsurgical mortality was comparable within both groups. No patient died within 30 or 90 days after surgery while the 1-year survival rate was 72.2% for nCRT and 68.0% for pCT (p = 0.47). Only grade 3a complications according to Clavien–Dindo were increased after pCT (p = 0.04). There was a trend towards a higher rate of pylorospasm within the pCT group (nCRT: 23.7% versus pCT: 37.1%) (p = 0.061). Multivariate analysis identified pCT, younger age, and Charlson score as independent variables for pylorospasm. Conclusion Both nCRT and pCT are safe and efficient within the multimodal treatment of esophageal/gastroesophageal adenocarcinoma. We did not observe differences in postoperative morbidity. However, functional aspects such as gastric emptying might be more frequent after pCT.

scholarly journals Current state of surgical treatment for patients with tubular breast type II (a literature review)

2021 ◽  
Vol 23 (1) ◽  
pp. 146-151
Author(s):  
A. A. Kostenko ◽  
S. P. Galych ◽  
O. Yu. Dabizha ◽  
K. A. Samko ◽  
D. V. Borovyk
Keyword(s):  
Surgical Treatment ◽  
Soft Tissues ◽  
Surgical Techniques ◽  
Fat Grafting ◽  
Universal Method ◽  
Type Ii ◽  
Lower Pole ◽  
Current State ◽  
Tubular Breast ◽  
High Level

The aim of the study – to analyze the modern literature, summarize current approaches to surgical treatment of tubular breast type II and identify the causes of poor results. Tubular breast deformity relates to congenital connective tissue malformations, occurs in puberty and causes a great deal of psychological discomfort to women. The majority of authors note that type II of tubular breast is the most common among patients referred to clinic for a surgical correction. In fact, the correction of this type of malformation is a reconstructive procedure associated with a number of challenges. The goal of such operation is not only to increase a volume of the breast lower pole, but also to cover the implant maximally using soft tissues to achieve a normal lower pole contour. To date, a number of surgical techniques have been proposed to address these problems, such as C. Puckett and M. Concannon (1990), L. Ribeiro (1998), E. Muti (1996), A. Mandrekas (2003) and their modern modifications. Fat grafting techniques in treatment of tubular breast are also getting popular, but all have some drawbacks. Conclusions. A high level of complications and the absence of a universal method for correction of tubular breast type II are preconditions for improving the surgical technique to correct this pathology.

Surgical treatment of pancreatic cancer

2018 ◽  
Vol 90 (2) ◽  
pp. 45-53 ◽  
Author(s):  
Wioletta Masiak-Segit ◽  
Karol Rawicz-Pruszyński ◽  
Magdalena Skórzewska ◽  
Wojciech P. Polkowski
Keyword(s):  
Surgical Treatment ◽  
Lymph Nodes ◽  
English Literature ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Surgical Techniques ◽  
Pancreatic Tumors ◽  
R0 Resection ◽  
Pancreas Head ◽  
Head Of The Pancreas

The only way to cure the patient with adenocarcinoma of the pancreas (RT) is surgical excision of the tumor. The standard surgical treatment of resectable pancreatic carcinoma is considered the classic pancreatoduodenectomy (PD) with the Kausch- Whipple procedure, or the pylorus-preserving PD with the Traverso-Longmire method. The most difficult technically and at the same time the most important PD stage from an oncological point of view is the separation of the head of the pancreas from the superior mesenteric artery. Over the last decades several PD modifications have been developed, focusing on this maneuver in the early phase of the operation, i.e. before the pancreas is cut (an irreversible stage of the procedure). These procedures in the English literature are called “artery-first approach” or “SMA-first approach”. The term “mesopancreas” was created. Complete removal of the mesopancreas together with the proximal part of the jejunum is considered an R0 resection in the case of a tumor of the head of the pancreas with direct or indirect vascular invasion, or metastases to regional lymph nodes, and in English literature it is referred to as pancreatoduodenectomy with systematic mesopancreas dissection (SMDPD). Distal resection of the pancreas (DRT) due to cancer, is associated with a high percentage of positive margins, insufficient number of removed lymph nodes, low survival rates. A new technique was developed - a radical proximal-distal modular pancreatosplenectomy (RAMPS). In RAMPS, surgical operations proceed from the side of the pancreas head towards the tail, the pancreas is cut early, and the splenectomy is performed at the final stages of the procedure. Currently, following the PD model, attempts are made to further modify the original RAMPS technique, especially in the direction of SMA-first approach. In patients with borderline resectable pancreatic tumors or locally advanced tumors, after neoadjuvant treatment, a technique of radical resection with preservance of arterial vessels - “the TRIANGLE operation” has been elaborated. Despite the tremendous progress of surgical techniques, RT is still detected too late in the phase preventing effective resection.

scholarly journals Laparoscopic and left thoracoscopic Ivor-Lewis esophagectomy for Siewert type II esophagogastric junction cancer with right aortic arch: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Motoki Murakami ◽  
Yasutaka Nakanishi ◽  
Yudai Hojo ◽  
Tatsuro Nakamura ◽  
Tsutomu Kumamoto ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Esophagogastric Junction ◽  
Right Aortic Arch ◽  
Type Ii ◽  
Siewert Type ◽  
Ivor Lewis ◽  
Siewert Type Ii ◽  
Ivor Lewis Esophagectomy ◽  
Lateral Decubitus ◽  
The Right

Abstract Background Right aortic arch (RAA) is a congenital malformation detected in 0.04% of the population without heterotaxia and makes esophagectomy and mediastinal lymphadenectomy difficult. A left thoracic approach is recommended in patients with RAA, but a minimally invasive procedure has not yet been established. Case presentation The case was a 40-year-old man with RAA and Siewert type II adenocarcinoma of the esophagogastric junction with metastases to the adrenal glands and paraaortic lymph nodes. Conversion surgery was performed when radiologic disappearance of metastatic disease was confirmed after first-line treatment consisting of 12 cycles of S-1 plus platinum-based systemic chemotherapy. Minimally invasive laparoscopic and left thoracoscopic Ivor-Lewis esophagectomy was performed in the right semi-lateral decubitus position. The esophagus was easy to see on left thoracoscopy because of the RAA. Esophagectomy with lower mediastinal lymphadenectomy and an intrathoracic esophagogastric anastomosis was performed successfully with laparoscopy and thoracoscopy without a position change. There were no surgical complications, and no residual cancer was detected in the resected specimen on pathological examination. There has been no recurrence during 21 months of follow-up. Conclusions Laparoscopic and left thoracoscopic Ivor-Lewis esophagectomy in the right semi-lateral decubitus position is a minimally invasive, anatomically novel procedure for Siewert type II esophagogastric junction cancer in patients with RAA.

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