PS02.204: GASTRIC TUBE CANCER AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER: A SYSTEMATIC REVIEW

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 180-180
Author(s):  
Damiano Gentile ◽  
Pietro Riva ◽  
Anna Da Roit ◽  
Silvia Basato ◽  
Salvatore Marano ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Gastric Tube ◽  
Conflicts Of Interest ◽  
Case Reports ◽  
Treatment Strategies ◽  
Vocal Cord Palsy ◽  
Review Literature ◽  
Gastric Tube Cancer ◽  
Publication Number

Abstract Background Gastric conduit used for reconstruction after esophagectomy for esophageal cancer (EC) has the potential to develop a metachronous cancer known as gastric tube cancer (GTC). The aim of our study was to review literature and evaluate outcomes and possible treatment strategies for GTC. Methods A comprehensive systematic literature search was conducted using PubMed. No restriction was set for type of publication, number, age and sex of patients. Study language was limited to English. Characteristics of EC and its treatment and GTC and its treatment were analyzed. Results A total of 26 studies were analyzed, 10 retrospective analysis and 16 case reports, involving 170 patients, 17 patients (10%) were affected by multifocal GTC. 143 ECs (84,1%) were squamous cell carcinomas. In 95 patients (55,9%) a posterior-mediastinal reconstructive route was used at the time of esophagectomy for EC. Mean interval between esophagectomy and diagnosis of GTC was 67,18 months (4–236 months). 184 GTCs were metachronous lesions (98,4%). 164 GTCs were adenocarcinomas (98,2%). 84 GTCs were located in the lower part of the gastric tube. 88 patients were endoscopically treated. 63 patients underwent surgery. 30 total gastrectomies + limphoadenectomy with colon or jejunal interposition were performed. 27 subtotal gastrectomies and 6 wedge resections were performed. Main reported post-operative complications were: anastomotic leak, vocal cord palsy and respiratory failure. 19 patients were treated with chemoradiotherapy and palliative care. 68,2% of endoscopically treated patients, 63,5% of surgically resected patients and 5,2% of patients who underwent chemoradiotherapy were alive at a mean follow-up of 25,5 months. Feasibility of endoscopic resections in patients diagnosed with superficial GTC has been established. Surgical treatment represents the preferred treatment modality in operable patients with locally invasive tumor. Patients treated with conservative therapy have a scarce prognosis. Conclusion Yearly endoscopic follow-up is of paramount importance in patients who underwent esophagectomy for EC with gastric tube reconstruction. At least, a 10-year endoscopic surveillance is recommended. Disclosure All authors have declared no conflicts of interest.

scholarly journals Gastric tube cancer after esophagectomy for cancer: a systematic review

2019 ◽  
Vol 32 (8) ◽  
Author(s):  
Damiano Gentile ◽  
Pietro Riva ◽  
Anna Da Roit ◽  
Silvia Basato ◽  
Salvatore Marano ◽  
...  
Keyword(s):  
Gastric Tube ◽  
Case Reports ◽  
Survival Rates ◽  
Review Literature ◽  
Cochrane Library ◽  
Invasive Tumor ◽  
Gastric Tube Cancer ◽  
Publication Number ◽  
Esophagectomy For Cancer

SUMMARY Gastric conduit used for reconstruction after esophagectomy for cancer has the potential to develop a metachronous neoplasm known as gastric tube cancer (GTC). The aim of this study was to review literature and evaluate outcomes and possible treatment strategies for GTC. A comprehensive systematic literature search was conducted using PubMed, EMBASE, Scopus, and the Cochrane Library Central Register of Controlled Trials. No restriction was set for the type of publication, number, age, or sex of the patients. The search was limited to articles in English. Characteristics of esophageal cancer (EC) and its treatment and GTC and its treatment were analyzed. A total of 28 studies were analyzed, 12 retrospective analyses and 16 case reports, involving 229 patients with 250 GTCs in total. The majority of ECs (88.2%) were squamous cell carcinomas. In 120 patients (52.4%) a posterior mediastinal reconstructive route was used when esophagectomy was performed. The mean interval between esophagectomy and diagnosis of GTC was 55.8 months, with a median interval of 56.8 months (4–236 months). One hundred and twenty-four GTCs (49.6%) were located in the lower part of the gastric tube. One hundred and forty patients were endoscopically treated. Eighty-five patients underwent surgery. Thirty-six total gastrectomies with lymphadenectomy with colon or jejunal interposition were performed. Forty-three subtotal gastrectomies and 6 wedge resections were performed. The main reported postoperative complications were anastomotic leak, vocal cord palsy, and respiratory failure. Twenty-five patients were treated with palliative chemotherapy. Three-year survival rates were 69.3% for endoscopically treated patients, 58.8% for surgically resected patients, and 4% for patients who underwent palliative treatment. The feasibility of endoscopic resections in patients diagnosed with superficial GTC has been reported. Surgical treatment represented the preferred treatment method in operable patients with locally invasive tumor. Patients treated with conservative therapy have a scarce prognosis. The development of GTC should be taken into consideration during the extended follow-up of patients undergoing esophagectomy for cancer. Total gastrectomy plus lymphadenectomy should be considered the preferred treatment modality in operable patients with locally invasive tumor, when endoscopy is contraindicated. Long-term yearly endoscopic follow-up is recommended.

Treatment strategy for benign gastric tube-tracheobronchial fistula after esophagectomy for esophageal cancer: 9 case reports and review of the literature

Esophagus ◽  
2013 ◽  
Vol 10 (3) ◽  
pp. 135-143 ◽  
Author(s):  
Shirou Kuwabara ◽  
Akiko Tonouchi ◽  
Shoichi Manabe ◽  
Natsuru Sudo ◽  
Tomohiro Katada ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Treatment Strategy ◽  
Gastric Tube ◽  
Case Reports ◽  
Review Of The Literature

PS01.018: PERSISTENT DYSPHAGIA AFTER FUNDOPLICATION WITH MESH PLASTY –MISSED OR MISTAKEN –A CASE REPORT

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 55-55
Author(s):  
Servarayan Chandramohan ◽  
Visvarath Varadharajan ◽  
Madeshwaran Chinnathambi ◽  
Kanagavel Manickavasagam ◽  
Abishai Jebaraj ◽  
...  
Keyword(s):  
Skin Biopsy ◽  
Mesh Repair ◽  
Conflicts Of Interest ◽  
Case Reports ◽  
Systemic Disease ◽  
Transhiatal Esophagectomy ◽  
High Resolution Manometry ◽  
Failed Fundoplication ◽  
Rule Out

Abstract Background Scleroderma esophagus is a rare entity. Only few case reports of esophagectomy were done and reported for this condition. We are presenting this rare case of failed fundoplication and mesh repair with a diagnosis of GERD and hiatus hernia, which was found later on due to Scleroderma with Esophageal involvement. Methods 58 year old female admitted with dysphagia following laproscopic fundoplication with mesh repair of crura with a diagnosis of GERD and hiatus hernia.She presented with persistent vomiting and loss of weight.On evaluation, her Upper GI scopy revealed dilated esophagus with sluggish peristalisis. Since the patient had tightness of skin over the distal extremities, face and fish mouth appearance with thinning of nail, Skin biopsy was taken. The skin biopsy was reported to be scleroderma.The esophageal manometry demonstrated failed esophageal peristalisis with high normal LES pressure due to tight fundal wrap.The patient was treated with mesh remova, Transhiatal esophagectomy with gastric pull-up and cervical Anastomosis.Post operatively the patient was treated with hydrocholoroquine and predinisolone. Results The patient is free of dysphagia and is on regular follow up. Conclusion In case of failure, detailed evaluation including High resolution manometry (MII HRM) has to be done before doing laparoscopic fundoplication for GERD has to rule out uncommon and rare disorders of esophagus. Detailed clinical examination in GERD patients has to be done to rule out systemic disease like scleroderma.In case of failed fundoplication for GERD, patients have to investigated for the failure.So patients with incapacitating esophageal neuromotor disease, a more radical approach in the form of esophagectomy may be safer and more reliable than attempting another procedure and risk another failure. Disclosure All authors have declared no conflicts of interest.

PS01.155: ANALYSIS ON THE INCIDENCE AND RISK FACTOR OF READMISSION AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER FOR ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 93-93
Author(s):  
Seong Yong Park ◽  
Dae Joon Kim ◽  
Jee Won Suh ◽  
Go Eun Byun
Keyword(s):  
Esophageal Cancer ◽  
Anastomotic Leakage ◽  
Conflicts Of Interest ◽  
Anastomotic Stricture ◽  
Oral Intake ◽  
Vocal Cord Palsy ◽  
Jejunostomy Tube ◽  
The Mean ◽  
Secondary Hospital ◽  
Wound Problem

Abstract Background Esophageal complications consensus group (ECCG) recommended that readmissions to primary or secondary hospital within 30 days of discharge after esophagectomy can be an important quality outcome indicator for esophagectomy. This retrospective study was performed to investigate the frequencies and risk factors for readmission after esophagectomy. Methods We retrospectively reviewed 291 patients who received the esophagectomy and mediastinal lymphadenectomy for curative aim from January 2006 to June 2017. Results The mean age was 63.02 ± 8.02 years and male patients were 264 (90.7%). Thirty-nine (13.4%) patients readmit within 30 days after discharge. The mean readmission day after discharge was 14.76 ± 8.84. The common causes of readmission were anastomotic stricture requiring the ballooning (12, 30.7%), wound problem (7, 17.9%), pneumonia (6, 15.4%), and poor oral intake (4, 10.2%). Other causes of readmission were delayed gastric emptying (3), jejunostomy tube problem (2), ileus (2), pain (1), pneumothorax (1) and pleural effusion (1). On multivariate analysis, anastomotic leakage (odd ratio = 2.872, P = 0.022) were related to readmission, whereas age, pathologic stage, vocal cord palsy and neoadjuvant therapy were not related to readmission. In 30 patients with postoperative anastomotic leakage, the frequency of readmission due to wound problem (13.3% vs. 1.1%, P = 0.003) and anastomotic stricture (13.3% vs. 3.4%, P = 0.034) were significantly higher. Conclusion The incidence of readmission within 30 days after discharge was 13.4% and postoperative anastomotic leakage was related to the readmission, and it might be related to the wound problem and anastomotic stricture. Disclosure All authors have declared no conflicts of interest.

scholarly journals Sertoli-Leydig Cell Tumor with Concurrent Rhabdomyosarcoma: Three Case Reports and a Review of the Literature

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Trisha Plastini ◽  
Arthur Staddon
Keyword(s):  
Leydig Cell ◽  
Malignant Tumors ◽  
Case Reports ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Salvage Chemotherapy ◽  
Response To Chemotherapy ◽  
One Year ◽  
Lost To Follow Up

Sertoli-Leydig Cell Tumors (SLCTs) make up <1% of all ovarian tumors and are benign or malignant, androgen-secreting tumors. Rhabdomyosarcoma (RMS) is a heterogeneous group of malignant tumors that resemble developing skeletal muscle. There have been case reports of patients with concurrent SLCT and RMS with limited treatment options. We aim to demonstrate treatment strategies used in our patients, which seemed to have prolonged survival when compared to prior case reports of patients not cured by surgical resection. Herein we describe 22 cases of SLCT with RMS elements as discussed in prior case reports and three cases from the authors’ institution. Of the 19 cases from prior case reports, five were lost to follow-up and two had NED after surgical intervention. Eleven patients had recurrence and were deceased within one year. Of those patients not surgically cured, only three patients were documented as living beyond two years, all of whom received chemotherapy. The three patients presented from our institution had clinical evidence of response to chemotherapy that is traditionally used for RMS. In conclusion, chemotherapy with doxorubicin and ifosfamide has activity in patients with SLCT and RMS as does salvage chemotherapy with vincristine, irinotecan, and temozolomide.

scholarly journals Esophageal Cancer After Bariatric Surgery: Increasing Prevalence and Treatment Strategies

2021 ◽  
Author(s):  
Victor D. Plat ◽  
Anne Kasteleijn ◽  
Jan Willem M. Greve ◽  
Misha D. P. Luyer ◽  
Suzanne S. Gisbertz ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Esophageal Cancer ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Loss To Follow Up ◽  
Multicenter Cohort ◽  
Incidence And Mortality ◽  
Individualized Approach ◽  
Post Bariatric Surgery

Abstract Purpose The number of bariatric procedures has increased exponentially over the last 20 years. On the background of ever-increasing incidence of esophageal malignancies, the altered anatomy after bariatric surgery poses challenges in treatment of these cancers. In this study, an epidemiological estimate is presented for the future magnitude of this problem and treatment options are described in a retrospective multicenter cohort. Methods The number of bariatric procedures, esophageal cancer incidence, and mortality rates of the general population were used for epidemiological estimates. A retrospective multicenter cohort was composed; patients were treated in three large oncological centers with a high upper gastrointestinal cancer caseload. Consecutive patients with preceding bariatric surgery who developed esophageal cancer between 2014 and 2019 were included. Results Approximately 3200 out of 6.4 million post bariatric surgery patients are estimated to have developed esophageal cancer between 1998 and 2018 worldwide. In a multicenter cohort, 15 patients with esophageal cancer or Barrett’s esophagus and preceding bariatric surgery were identified. The majority of patients had a history of Roux-en-Y gastric bypass (46.7%) and had an adenocarcinoma of the distal esophagus (60%). Seven patients received curative surgical treatment, five of whom are still alive at last follow-up (median follow-up 2 years, no loss to follow-up). Conclusion Based on worldwide data, esophageal cancer development following bariatric surgery has increased over the past decades. Treatment of patients with esophageal cancer after bariatric surgery is challenging and requires a highly individualized approach in which optimal treatment and anatomical limitations are carefully balanced. Graphical abstract

scholarly journals Bio-C Repair - A New Bioceramic Material for Root Perforation Management: Two Case Reports

2021 ◽  
Vol 32 (1) ◽  
pp. 104-110
Author(s):  
Kênia Soares de Toubes ◽  
Stephanie Quadros Tonelli ◽  
Caroline Felipe Magalhães Girelli ◽  
Camila Grasielle de Sá Azevedo ◽  
Ana Carolina Tocafundo Thompson ◽  
...  
Keyword(s):  
Case Reports ◽  
Treatment Strategies ◽  
Cone Beam ◽  
Radiographic Assessment ◽  
Fiber Post ◽  
Canal System ◽  
Gutta Percha ◽  
Glass Fiber Post ◽  
One Year

Abstract These case reports aimed to describe the management of lateral perforation in the middle cervical third of the root in two maxillary incisors with pulp canal calcification using Bio-C Repair, with safe and viable clinical treatment strategies. Digital radiographic exams were obtained with different angles and analyzed using different filters. Cone-beam computed tomography (CBCT) images were requested to show the actual position of the canal, location of the perforation, and guide the strategic planning of the case. Subsequently, cavity access was prepared with the aid of dental operating microscopy. After perforation was identified, granulation tissue was removed and the original canal was identified and then dressed with calcium hydroxide. In the second visit, the perforation was filled with Bio-C Repair and the canal system filled with gutta-percha points and a root canal sealer (Bio-C Sealer). The teeth were restored with glass fiber post, 4 mm beyond the perforation level, and provisory crowns. Both teeth treated as described above were functional and asymptomatic with a 1-year clinical and radiographic assessment. The Bio-C Repair is suggested as a new cement option for the management of lateral canal perforations, with effective results as observed after a one-year follow-up.

PS02.150: SEVEN PATIENTS WITH GASTRIC-TUBE CANCER AFTER ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 163-164
Author(s):  
Shin Saito ◽  
Yoshinori Hosoya ◽  
Takashi Ui ◽  
Joji Kitayama ◽  
Rihito Kanamaru ◽  
...  
Keyword(s):  
Gastric Tube ◽  
Conflicts Of Interest ◽  
Early Stage ◽  
Palliative Therapy ◽  
Suture Line ◽  
Anterior Chest Wall ◽  
Upper Gastrointestinal Endoscopy ◽  
Gastric Tube Cancer ◽  
Working Space ◽  
H Pylori

Abstract Background The prolonged survival of patients receiving surgery for esophageal cancer has led to an increased incidence of adenocarcinoma arising in the gastric tube used for reconstruction (gastric tube cancer). The incidence of gastric tube cancer after esophagectomy has been reported to be 1.3–6.3% in Japan. Patients with early stage gastric tube cancer can be treated by endoscopic resection, however patients with advanced gastric tube cancer need to undergo the resection of the gastric tube. Methods A total of 497 patients underwent esophagectomy with gastric tube reconstruction between 2001 and 2015 at our institution. During the same period, gastric tube cancer was detected in seven patients including three by endoscopic submucosal dissection (ESD) and three by surgery. We investigated the clinicopathological study of these seven patient with gastric tube cancer. Results The incidence of gastric tube cancer was 1.4% (7/497) at our hospital. Average age was 73 years old (range, 62–84). Six patients were men and one was women. Average interval from esophagectomy to initial treatment was 78.3 ± 61.0 (months). Among seven patients with gastic tube cancer, three were treated by ESD and 3 underwent surgery. One patient went to a palliative therapy. All seven patient with gastric tube cancer, who didn’t have specific complains, were detected by regular upper gastrointestinal endoscopy. We observed a very high proportion of patients with H. pylori infection (at least five patients among seven). Conclusion ESD for gastric tube cancer after esophagectomy is a technically difficult procedure because of the limited working space and unusual fluid-pooling area in the reconstructed gastrictube as well as the presence of severe gastric fibrosis with staples under the suture line. A highly skilled endoscopist can perform the procedure successfully. An operative technique for the resection of gastric tube cancer by means of lifting the anterior chest wall and video scope-assisted surgery enabled the resection of gastric tube without performing a sternotomy. Disclosure All authors have declared no conflicts of interest.

287 OUTCOMES OF DEFINITIVE CHEMORADIOTHERAPY IN LONG SEGMENT ESOPHAGEAL CANCERS FROM A TERTIARY CANCER CENTRE IN INDIA

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Jaiprakash Agarwal ◽  
Anil Tibdewal ◽  
Carlton Johnny ◽  
Pradnya Chopade ◽  
Naveen Mummudi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Dose Reduction ◽  
Dose Group ◽  
Standard Dose ◽  
Organs At Risk ◽  
Treatment Strategies ◽  
Squamous Carcinoma ◽  
Definitive Chemoradiotherapy ◽  
Esophageal Cancers

Abstract   Definitive chemoradiotherapy (CTRT) is the standard of care for unresectable esophageal cancer. Long segment esophageal primary disease makes it challenging to deliver radiation doses needed to achieve good local control without exceeding normal tissue tolerance to the surrounding organs at risk (OAR). We report our experience and outcomes of such patients where the RT doses were reduced from our institutional standard of 63Gy to 50.4Gy. Methods Between Jan 2017 and Dec 2019, 30/232 consecutive esophageal cancer patients were identified with long segment disease that required dose reduction from 63 to 50.4Gy and were included in this analysis. For this study, we divided nodal regions by their location into cervical, mediastinal, and gastro-hepatic. We generated and compared dosimetric parameters of the standard dose (63Gy) plan with that of treated low-dose plan (50.4Gy) using paired t-test. We also evaluated the patterns of recurrence and have reported them as local relapse (LR), loco-regional relapse (LRR), and distant metastases (DM). Results The median age was 55.5 years; 16 (53.3%) were males and 28 (93.3%) had squamous carcinoma. Single nodal site was involved in 6(20%), 2 sites in 20(66.7%) and 3 sites in 4 (13.3%). Median GTV and PTV length were 7.9 cm (IQR:6.4–9.7 cm) and 18.8 cm (IQR:14.08–22.31 cm) respectively. Median OAR doses with standard Vs treated plan achieved were: Total lung V20 and V5:28 Vs 22.14% (p = 0.00), and 81 Vs 70.5% (p = 0.005) respectively, and heart V20:70.92% Vs 64.7% (p = 0.000). No patients experienced ≥grade2 lung toxicity. After a median follow up of 8.4 months, 3 patients experienced LRR and 1 developed DM. Conclusion Treatment of long segment esophageal cancers warrants dose reduction to avoid higher doses to OAR like lung and heart. Early loco-regional and distant failures suggest need for improved treatment strategies or dose escalation with more conformal techniques like proton therapy. Longer follow-up is necessary to assess the median LR, LRR rates and overall survival for this reduced dose group as compared to the standard dose group.

Incidence of Progressive Multifocal Leukoencephalopathy in Non-Hodgkin Lymphoma Patients Treated with Rituximab.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3675-3675 ◽  
Author(s):  
Daniele Focosi ◽  
Marco Tuccori ◽  
Corrado Blandizzi ◽  
Mario Del Tacca ◽  
Mario Petrini
Keyword(s):  
Progressive Multifocal Leukoencephalopathy ◽  
Incidence Rate ◽  
Conflicts Of Interest ◽  
Case Reports ◽  
Rare Complication ◽  
Potential Contribution ◽  
Rate Analysis ◽  
Non Hodgkin Lymphoma ◽  
Clinical Records

Abstract Abstract 3675 Poster Board III-611 Progressive multifocal leukoencephalopathy (PML) is a rare complication of immunesuppression due to productive reactivation of JC polyomavirus (JCV) in glial cells. In the last decades many case reports of rituximab-associated PML have raised concerns, but no systematic incidence rate analysis has been ever performed. We retrospectively reviewed our clinical records with the aim of calculating the incidence rate of PML in patients with NHL who had been treated with regimens including rituximab. Data on HIV-negative patients who received the first dose of rituximab from January 1, 2000 to June 30, 2008, were analyzed. The follow-up period was from the first rituximab dose to the last recorded visit, up to September 30, 2008. PML cases were included if symptoms occurred at least 1 month after the first dose of rituximab and the diagnosis was supported by magnetic resonance imaging and detection of JCV DNA in stereotactic brain biopsies and/or cerebrospinal fluid. We collected data from 821 consecutive patients throughout the follow-up period. All patients received chemotherapy other than rituximab, and all completed their entire treatment course at the Hematology Unit in Pisa. No radiation therapy was administered. The median time of follow-up was 20 months (range = 1-106 month), resulting in 1725 patient-years at risk. Five cases of PML (two receiving maintenance rituximab) were identified, with an incidence rate of 2.89 cases per 1000 patient-years. We found that the incidence rate of PML in our population exceeded that observed in patients who are traditionally regarded as being at high risk of PML, namely patients with B-cell chronic lymphocytic leukaemia and AIDS. Rituximab might be a potential contributing factor to the development of PML in these patients. Nevertheless, rituximab currently represents an essential therapeutic tool that can positively affect the natural history of NHL. However, because of the expanding therapeutic indications, it seems reasonable to investigate the potential contribution of rituximab to PML occurrence. Disclosures: No relevant conflicts of interest to declare.

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