Proximal Gastric Resection with Posterior Esophago-Gastrostomy and Partial Neo-Fundoplication in the Treatment of Advanced Upper Gastric Carcinoma

Background: Proximal gastric resection (PGR) is rarely used in western countries because of frequent postoperative reflux and uncommon diagnosis of early gastric cancer (GC). Objectives: We hypothesized that the PGR with an anti-reflux procedure may be an attractive option even in advanced proximal GC after downstaging with the neo-adjuvant chemotherapy. Method: A novel technique of end-to-side esophago-gastrostomy with the posterior wall of the gastric stump and partial neo-fundoplication to prevent reflux symptoms has been introduced. An observational retrospective study was undertaken to evaluate early and late outcomes of the innovative technique in patients with advanced proximal GC after neoadjuvant chemotherapy. Results: Twenty consecutive patients with the diagnosis of loco-regionally advanced GC, localized in the subcardiac region or proximal upper third of the stomach, were selected for the study. Eleven (55%) patients completed preoperative neo-adjuvant chemotherapy. The mean postoperative hospitalization time was 13.3 (± 8.3) days. There was one postoperative in-hospital death due to acute circulatory insufficiency. The mean comprehensive complication index was 11.94 (±24.82). Two patients were diagnosed with a complete pathological response (ypT0N0). Median survival was 41.8 (95% CI 27.9–41.8) months. The 5-year survival rate was 42%. At a median follow-up of 26 months, reflux symptoms were present in 7 (35%) patients who had to use antireflux medication. Anastomotic stenosis was observed in 1 patient during the follow-up. Mean scores of reflux symptoms on medication were not significantly different to those in patients without medication. The Overall Satisfaction Score for patients on medication was 7.57 ± 1.92, whereas it was 8.83 ± 1.34 (p = 0.2; Student t test) for those with no medication. Conclusions: Proximal gastrectomy is feasible and may be safely used in patients with advanced GC after neo-adjuvant chemotherapy with acceptable survival. Posterior esophago-gastrostomy with partial neo-fundoplication reduces the postoperative reflux, while patients with persistent reflux symptoms can be effectively treated with an antireflux therapy.

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A Novel Method of Piggyback Jejunal Interposition Reconstruction Single-Tract Reconstruction After Proximal Gastrectomy for Siewert II and III Adenocarcinoma of the Esophagogastric Junction with a Diameter <4 cm

10.21203/rs.3.rs-1131676/v1 ◽

2021 ◽

Author(s):

Yuchao Ma ◽

Jianhong Dong ◽

Baoqing Ren ◽

Wanhong Zhang ◽

Liqiang Lei ◽

...

Keyword(s):

Reflux Esophagitis ◽

Complication Rate ◽

Esophagogastric Junction ◽

Proximal Gastrectomy ◽

Jejunal Interposition ◽

Reflux Symptoms ◽

Postoperative Reflux ◽

Novel Method ◽

The Mean ◽

Jejunal Interposition Reconstruction

Abstract Background Digestive tract reconstruction after proximal gastrectomy (PG) has been extensively discussed. Herein, we introduce a novel method of PG with piggyback jejunal interposition reconstruction single-tract reconstruction (PJIRSTR) for Siewert II and III adenocarcinoma of the esophagogastric junction (AEG) with a diameter <4 cm, and investigate its safety, practicability, and short-term and long-term clinical outcomes of this procedure. Method The clinical data of 33 patients with Siewert II or Siewert III AEG who underwent PJIRSTR in Shanxi Cancer Hospital from July 2013 to November 2016 were retrospectively reviewed. Data of clinicopathologic characteristics, postoperative and surgical outcomes, and follow-up findings, especially postoperative reflux esophagitis and postoperative reflux symptoms, were analyzed.Results The mean operation time was 136.7±22.4 (range: 110-180) min, including 32.3 ± 5.0(range: 26-45) min of the digestive tract reconstruction; the mean estimated blood loss was 87.6±18.1 mL; the mean number of dissected lymph nodes was 14.7±5.1; and the mean duration of postoperative hospitalization was 7.5±1.2 days. The early complication rate was 9% (n=3), including one case each of anastomotic bleeding, incision infection, and ileus. The late complication rate was 6% (n=2): both patients had gastroesophageal reflux symptoms (Visick grade II), but only one patient had Los Angeles grade B reflux esophagitis by endoscopy. Conclusion PJIRSTR is a safe, feasible, and innovative reconstruction method after PG for patients with Siewert II and III AEG with a diameter <4 cm. Furthermore, it has excellent efficiency in terms of preventing reflux symptoms and reflux esophagitis after surgery.

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Neoadjuvant Chemotherapy for Breast Cancer: Evaluation by PET / CT

QJM ◽

10.1093/qjmed/hcab106.065 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Rania Ali Maarouf ◽

Amgad S Abdel-Rahman ◽

Samar Ibrahim Mohamed

Keyword(s):

Breast Cancer ◽

Adjuvant Chemotherapy ◽

Therapeutic Response ◽

Left Breast ◽

Breast Lesions ◽

Mean Values ◽

Pet Ct ◽

The Mean ◽

Neo Adjuvant Chemotherapy ◽

Fdg Pet Ct

Abstract Background Breast cancer (BC)is the most commonly occurring cancer in women and the second most common cancer overall.An increase in the rate of breast preservation has come to be expected because of tumor reduction using neo-adjuvant chemotherapy (NAC) for locally advanced cancer and it is important to accurately determine the effects of NAC. Patients and Methods This study was conducted on 30 female patients with histopathologically confirmed breast cancer referred for a PET/CT scan aiming to demonstrate the role of 18F-FDG PET/CT in detecting the pathological response to NAC in BC patients. Results No statistically significant differences were found between the baseline number of lesions and that after three cycles of chemotherapy. Also, no statistically significant differences were found between the mean values of baseline and after three cycles of chemotherapy of both liver activity and size of right breast lesions. Meanwhile, the mean values of SUV of right and left breast lesions as well as the size of left breast lesions were significantly lower after three cycles of chemotherapy when compared to their baseline values. And no statistically significant differences were found between complete and partial therapeutic response in the right breast lesions as well as between complete and no therapeutic response in the left breast lesions as regards baseline SUV and SUV after 3 cycles of chemotherapy. Conclusion It can be concluded that FDG-PET/CT is useful for evaluation of neo-adjuvant chemotherapy for breast cancer. However, more studies are needed to validate the results of the current study.

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Novel Reconstruction Using Roux-en-Y Plus Antral Obstruction Following Proximal Gastrectomy: Feasibility and Quality of Life Benefits

10.21203/rs.2.11422/v1 ◽

2019 ◽

Author(s):

Dejun Yang ◽

Changming Wang ◽

Hongbing Fu ◽

Ziran Wei ◽

Xin Zhang ◽

...

Keyword(s):

Quality Of Life ◽

Reflux Esophagitis ◽

Proximal Gastrectomy ◽

Partial Gastrectomy ◽

Incidence Rates ◽

Reconstruction Method ◽

Reflux Symptoms ◽

Reconstruction Methods ◽

Postoperative Reflux

Abstract Background and Aims Routine gastroesophagostomy has been shown to have adverse effects on the recovery of digestive functions and quality of life because patients typically experience reflux symptoms after proximal gastrectomy. This study was performed to assess the feasibility and quality of life benefits of a novel reconstruction method termed Roux-en-Y anastomosis plus antral obstruction (RYAO) following proximal partial gastrectomy. Methods A total of 73 patients who underwent proximal gastrectomy from June 2015 to June 2017 were divided into two groups according to digestive reconstruction methods [RYAO (37 patients) and conventional esophagogastric anastomosis with pyloroplasty (EGPP, 36 patients)]. Clinical data were compared between the two groups retrospectively. Results The mean operative time for digestive reconstruction was slightly longer in the RYAO group than in the EGPP group. However, the incidence of postoperative short-term complications did not differ between the RYAO and the EGPP groups. At the 6-month follow-up, the incidence rates of both reflux esophagitis and gastritis were lower in the RYAO group than in the EGPP group (P = 0.002). Additionally, body weight recovery was better in the RYAO group (P = 0.028). The scale tests indicated that compared with the patients in the EGPP group, the patients in the RYAO group had significantly reduced reflux, nausea and vomiting and reported improvements in their overall health status and quality of life (all P < 0.05). Conclusion RYAO reconstruction may be a feasible procedure to reduce postoperative reflux symptoms and the incidence of reflux esophagitis and gastritis, thus improving patient quality of life after proximal gastrectomy.

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Clinical Outcome of Carotid Body Paraganglioma Management: A Review of 10-Year Experience

Journal of Oncology ◽

10.1155/2020/6081273 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Ahmed Elsayed Fathalla ◽

Mohammad Ahmad Elalfy

Keyword(s):

Adjuvant Chemotherapy ◽

Carotid Artery ◽

Carotid Body ◽

Ct Scanning ◽

Surgical Approaches ◽

R0 Resection ◽

Primary Malignancy ◽

Nerve Paralysis ◽

The Mean

Background. Carotid body paragangliomas are rare neoplasms usually benign, however sometimes presenting as highly aggressive tumors. Surgery is the main line of treatment. Purpose. To study and describe clinical presentations, surgical approaches, postoperative complications, and treatment outcomes. Materials and Methods. A single-institution retrospective analysis of 19 cases with carotid body paragangliomas who were candidates for surgery from January 2009 through January 2019 with a mean follow-up period of 58.8 months. Results. The mean age was 46 years with the female predominance of 63%. The mean size of the tumor was 4.3 cm. All cases were presented with a painless pulsating neck lump located anteriorly at the level of the hyoid bone. Neck US was done in all cases as a primary screening investigation. CT scanning was the second main investigation performed in 17 cases (89.5%) revealing tumors attached to the carotid artery at its bifurcation. Urinary catecholamine metabolites were measured in all cases to rule out familial functioning types. 5 cases (26.3%) were malignant. All cases were surgically approached through transcervical transverse incision. 11, 5, and 3 cases were classified as Shamblin’s type II, III, and I, respectively. All tumors were R0 resected with nodal neck dissection conducted in the malignant group. Major complications occurred in 4 cases (21%) during tumor dissection from the adventitia of carotid bifurcation. ECA ligation was performed in one case (5.3%). 2 patients (10.5%) suffered XII nerve paralysis. Carotid artery blowout occurred in one patient (5.3%) and was immediately controlled. No operative mortality occurred. All patients were free of disease during the follow-up period. 4 malignant cases (21%) suffered a systemic relapse to bone and lung metastasis justifying adjuvant chemotherapy, radiotherapy, or both. Conclusions. Surgery is the treatment of choice for carotid body paragangliomas. Complete R0 resection should be justified especially in case of malignancy. Adjuvant chemotherapy or radiotherapy is an option for patients with primary malignancy or relapse.

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Pre-Enucleation Chemotherapy in Advanced Intraocular Retinoblastoma. Central America Follow Up: AHOPCA II

Journal of Global Oncology ◽

10.1200/jgo.2016.004440 ◽

2016 ◽

Vol 2 (3_suppl) ◽

pp. 75s-75s

Author(s):

Sandra Luna-Fineman ◽

Soad L. Alabi ◽

Mauricio E. Castellanos ◽

Yessika Gamboa ◽

Ligia Fu ◽

...

Keyword(s):

High Risk ◽

Adjuvant Chemotherapy ◽

Central America ◽

Conflicts Of Interest ◽

Risk Group ◽

High Risk Group ◽

Globe Rupture ◽

Neo Adjuvant Chemotherapy ◽

Standard Risk

Abstract 57a Purpose: A significant percentage of patients in Central America present with buphthalmos, carrying a high risk of globe rupture and orbital contamination. In 2007, AHOPCA introduced chemotherapy before enucleation in children with buphthalmos. Methods: Patients with advanced intraocular disease were considered standard-risk and underwent enucleation. Those with diffuse invasion of choroid, postlaminar optic nerve, or anterior chamber invasion received 4-6 cycles of adjuvant chemotherapy (vincristine, carboplatin, etoposide). Patients with buphthalmos or perceived to be at risk for abandonment were considered high-risk, given 2-3 cycles of chemotherapy before enucleation to compete 6 cycles regardless of pathology. All cases were discussed via online meetings. Results: From 2007 to 2014, 396 patients were enrolled; 240 had IRSS stage I (174 unilateral). 143 had upfront enucleation, 95 had pre-enucleation chemotherapy, 1 is pending enucleation and 1 abandoned before enucleation. The standard-risk group 69 had risk pathology and 76 had no risk factors; 125 had no events, 5 abandoned 11 relapsed/progressed and 2 died of toxicity. Of 95 high-risk group, 8 abandoned, 20 relapse/progressive, 6 had toxic deaths and 61 are alive at last follow-up (median time of 4 years). Of high risk group, 55 were unilateral, 82% are alive. At 7 years OS (abandonment-censored) was 95±0.02 and 79±0.04 for standard-risk and high-risk (p=0.008). Conclusion: AHOPCA addressed advanced intraocular disease with an innovative approach. In eyes with buphthalmos and patients with risk of abandonment, neo-adjuvant chemotherapy is effective, when followed by post-enucleation chemotherapy. This approach avoids ocular rupture and intensified therapy, and reduces refusal/abandonment rate. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.

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Elective Percutaneous Coronary Interventions (PCI) in 100 Cases in a Centre Without On-site Cardiac Surgery Support

Medicine Today ◽

10.3329/medtoday.v24i1.14106 ◽

2013 ◽

Vol 24 (1) ◽

pp. 8-11

Author(s):

Md Nurul Afsar Badrul ◽

Kamal Ahmed ◽

Sufia Rahman

Keyword(s):

Success Rate ◽

Clinical Success ◽

Clinical Success Rate ◽

Hospital Death ◽

Percutaneous Coronary Interventions ◽

Vessel Disease ◽

Coronary Interventions ◽

Percutaneous Coronary ◽

The Mean

Since its introduction in 1977, Percutaneous Coronary Interventions (PCI) is an important tool in the treatment of coronary artery disease (CAD). It is a retrospective analysis of data of 100 cases (132 vessels). The mean age was 50.9 years (range 30-70) with 90 (90%) male and 10 (10%) female. Indication of PCI includes acute and old MI, Chronic stable angina and unstable angina were 48 (48%), 33 (33%) and 19(19%) respectively. Procedure done in total 132 vessels among 100 patients. most of the cases were single vessels disease (SVD) {68 (68%} followed by double vessel disease (DVD) {30(30%)} , triple vessel disease (TVD) {02 (02%)} and chronic total occlusion (CTO) {02 (02%)}.Cobalt chromium was commonly used stent (117 (88.6%) followed by drug illuting stent (DES) 12 (9.1%) and bare metal stent (BMS) 3 (2.3%). Among the site of the stent insertion left anterior descending (LAD) 62 (47%), right coronary lesion (RCA) 37 (28), left circumplex artery (LCX) 33 (25%).Maximum stent length was 35 mm, minimum 10mm. Maximum stent diameter was 3.5 mm whereas minimum diameter 2.5 mm. The mean pretreatment reference diameter was 2.55 ± 0.20 mm and post treatment diameter 2.70 ± 0.45 mm. Angiographic, procedural and clinical success rate were 100%, 98% and 98% respectively. Major adverse cardiovascular event (MACE) {periprocedural MI} occurred in 2 (02 %) cases. Minor cardiovascular complications revealed vascular haematoma 2 (02%), bleeding from access site in 1 (01%), transient ventricular fibrillation (VF) in 3 (03%) cases. There was no hospital death, emergency CABG before discharge from hospital. Angiographic, procedural and clinical success rate were excellent with a little MACE and event free survival within 30 days follow up. So, PCI is a safe and effective method of myocardial revascularization irrespective of lesion morphology and type of stents used at immediate and 30 days follow up. DOI: http://dx.doi.org/10.3329/medtoday.v24i1.14106 Medicine TODAY Vol.24(1) 2012 pp.8-11

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Does neo-adjuvant chemotherapy increase the risk of infection after limb salvage surgery for bone tumors?

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.20532 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 20532-20532

Author(s):

S. Sankaranarayanan ◽

V. Sokolovskiy ◽

V. Voloshin ◽

M. Aliev ◽

V. Zubikov ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

Limb Salvage ◽

Bone Tumors ◽

Salvage Surgery ◽

Limb Salvage Surgery ◽

Team Approach ◽

Group A ◽

Neo Adjuvant Chemotherapy ◽

Group B

20532 Background: Neo-adjuvant chemotherapy is commonly used to eradicate the micro metastases and to prepare the patient for limb-salvage surgery. It helps the surgeon to get good oncological margin intraoperatively. Methods: Between the period of 1992 - 2005, 321 patients underwent limb salvage surgery for bone tumors at the Department of General Oncology (Bone & Soft tissue tumors), N. N. Blokhin Russian Cancer Research Center & Moscow Regional Clinical Research Institute, Moscow, Russian Federation. 230/321 patients (Group A) received neo-adjuvant chemotherapy. The course of chemotherapy ranges from 2 to 11 cycles. 95/321 patients (Group B) did not receive neo-adjuvant chemotherapy. The histological diagnoses were: 155 - High grade osteosarcoma, 38 - Giant cell tumor, 36 - Malignant fibrous histiocytoma, 29 - Chondrosarcoma, 25 - Periosteal osteosarcoma, 21 - Metastasis from other organs and 17 - Ewing's tumor. Results: In Group A, 27 patients (11.7%) and in Group B, 7 (7.3%) had infection of endoprosthetic bed. Suppression of the immune system by chemotherapeutic agents is the main reason for the higher incidence of infection in Group A. All the 27 patients in Group A and 2 patients in Group B had revisional endoprosthetic replacement. In group A 7/27 and in Group B none of the 7 patients died of post operative infection. The follow-up ranged from 1 - 13 years (mean follow-up 6 years). Discussion: In our opinion, it has a major disadvantage, i.e. it increases the risk of postoperative infection. How best to combine this drug is still unknown. In the future, therapy for bone tumors should be enhanced by advances in pharmacology, immunology, and molecular genetics that will lead to more efficacious, specific and less toxic treatments. An interdisciplinary team approach is needed in order to advance the goal of local tumor control, limb salvage with optimum extremity function, minimal morbidity and improved long term survival. No significant financial relationships to disclose.

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Selective organ preservation with neo-adjuvant chemotherapy for the treatment of muscle invasive transitional cell carcinoma of the bladder

British Journal of Cancer ◽

10.1038/bjc.2015.109 ◽

2015 ◽

Vol 112 (10) ◽

pp. 1626-1635 ◽

Cited By ~ 14

Author(s):

S Hafeez ◽

A Horwich ◽

O Omar ◽

K Mohammed ◽

A Thompson ◽

...

Keyword(s):

Bladder Cancer ◽

Adjuvant Chemotherapy ◽

Organ Preservation ◽

Bladder Tumour ◽

Poor Responders ◽

Bladder Preservation ◽

Platinum Based Chemotherapy ◽

Neo Adjuvant Chemotherapy ◽

Muscle Invasive

Abstract Background: Radiotherapy for muscle invasive bladder cancer (MIBC) aims to offer organ preservation without oncological compromise. Neo-adjuvant chemotherapy provides survival advantage; response may guide patient selection for bladder preservation and identify those most likely to have favourable result with radiotherapy. Methods: Ninety-four successive patients with T2-T4aN0M0 bladder cancer treated between January 2000 and June 2011 were analysed at the Royal Marsden Hospital. Patients received platinum-based chemotherapy following transurethral resection of bladder tumour; repeat cystoscopy (±biopsy) was performed to guide subsequent management. Responders were treated with radiotherapy. Poor responders were recommended radical cystectomy. Progression-free survival (PFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan–Meier method; univariate and multivariate analyses were performed using the Cox proportional hazard regression model. Results: Response assessment was performed in 89 patients. Seventy-eight (88%) demonstrated response; 53 (60%) achieved complete response (CR); 74 responders had radiotherapy; 4 opted for cystectomy. Eleven (12%) demonstrated poor response, 10 received cystectomy. Median survival for CR was 90 months (95% CI 64.7, 115.9) compared with 16 months (95% CI 5.4, 27.4; P<0.001) poor responders. On multivariate analysis, only response was associated with significantly improved PFS, OS and DSS. After a median follow-up of 39 months (range 4–127 months), 14 patients (16%) required salvage cystectomy (8 for non-muscle invasive disease, 5 for invasive recurrence, 1 for radiotherapy related toxicity). In all, 82% had an intact bladder at last follow-up after radiotherapy; 67% had an intact bladder at last follow-up or death. Our study is limited by its retrospective nature. Conclusions: Response to neo-adjuvant chemotherapy is a favourable prognostic indicator and can be used to select patients for radiotherapy allowing bladder preservation in >80% of the selected patients.

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Impact of estrogen receptor levels on outcome in non-metastatic triple negative breast cancer patients treated with neoadjuvant/adjuvant chemotherapy

npj Breast Cancer ◽

10.1038/s41523-021-00308-7 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Maria Vittoria Dieci ◽

Gaia Griguolo ◽

Michele Bottosso ◽

Vassilena Tsvetkova ◽

Carlo Alberto Giorgi ◽

...

Keyword(s):

Breast Cancer ◽

Estrogen Receptor ◽

Adjuvant Chemotherapy ◽

Triple Negative Breast Cancer ◽

Triple Negative ◽

Complete Response ◽

Breast Cancer Patients ◽

Significant Difference ◽

Neo Adjuvant Chemotherapy

AbstractAlthough 1% is the recommended cut-off to define estrogen receptor (ER) positivity, a 10% cut-off is often used in clinical practice for therapeutic purposes. We here evaluate clinical outcomes according to ER levels in a monoinstitutional cohort of non-metastatic triple-negative breast cancer (BC) patients undergoing (neo)adjuvant chemotherapy. Clinicopathological data of 406 patients with ER < 10% HER2-negative BC treated with (neo)adjuvant chemotherapy between 01/2000 and 04/2019 were collected. Patients were categorized in ER-negative (ER < 1%; N = 364) and ER-low positive (1–9%, N = 42). At a median follow-up of 54 months, 88 patients had relapsed and 64 died. No significant difference was observed in invasive relapse-free survival (iRFS) and overall survival (OS) according to ER expression levels, both at univariate and multivariate analysis (5-years iRFS 74.0% versus 73.1% for ER-negative and ER-low positive BC, respectively, p = 0.6; 5-years OS 82.3% versus 76.7% for ER-negative and ER-low positive BC, respectively, p = 0.8). Among the 165 patients that received neoadjuvant chemotherapy, pathological complete response rate was similar in the two cohorts (38% in ER-negative, 44% in ER-low positive, p = 0.498). In conclusion, primary BC with ER1–9% shows similar clinical behavior to ER 1% BC. Our results suggest the use of a 10% cut-off, rather than <1%, to define triple-negative BC.

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