Gastrointestinal Tumors最新文献

Background: Gastric cancer is the fourth cause of cancer-related death in Europe and the prognosis of these patients remains dismal. It has been demonstrated that chemotherapy improved survival compared with best supportive care and recently, subsequent lines of therapy, also with new drugs, obtained positive results.

Summary: We present the case of a patient diagnosed with a de novo metastatic gastric cancer who experienced an extraordinary long response to multiple lines of chemotherapy (FOLFOX6, paclitaxel plus ramucirumab, FOLFIRI, rechallenge with FOLFOX6).

Key message: Gastric cancer therapy should be considered as the result of a strategy based on the patient's condition, and tolerance and response to various therapies. The emerging evidence of the role of subsequent lines of therapy, along with the recognition of the pivotal role of nutritional support and the availability of new drugs, should help clinicians in the management of patients with gastric cancer.

Practical implications: We propose a practical therapeutic algorithm in order to help clinicians who deal with patients with gastric cancer.

Background: Helicobacter pylori (HP) infection is one of the hypothesized infectious etiologies of gastric cancer (GC) and other gastroduodenal diseases. It was suggested that other infectious agents, including oncogenic viruses, may increase the risk of gastroduodenal diseases. A number of reports regarding JC polyomavirus (JCPyV) have shown that JCPyV could be implicated in colorectal cancer and gastrointestinal carcinogenesis.

Objective: The current investigation aimed to investigate whether JCPyV could have any association with the pathogenesis of gastroduodenal diseases either alone or together with HP.

Methods: A total of 237 fresh or formalin-fixed and paraffin-embedded gastroduodenal samples were examined by quantitative real-time polymerase chain reaction targeting the JCPyV large tumor antigen (LTag) oncogene, and viral load was determined as viral copy number/cell.

Results: In total, 2 out of 237 samples (0.8%) were positive for JCPyV LTag DNA. One positive sample derived from diffuse-type gastric adenocarcinoma (6.8 × 10^-3 copies/cell) and other JCPyV-positive sample obtained from a patient with gastritis (2.5 × 10^-3 copies/cell) were recorded. Both JCPyV-positive samples were negative for HP infection.

Conclusion: This study suggests no association between JCPyV infection and GC or other gastroduodenal diseases. The very low frequency of JCPyV LTag sequences in GC is an important aspect that weakens the hypothesis of the pathogenic role of JCPyV in gastric tumor induction.

Background: Major vessel invasion is a late manifestation of hepatocellular carcinoma, which may directly result in mortality if left untreated. Surgical resection may be an option for select patients; however, surgery may be contraindicated. Contraindications include multifocal disease, poor liver reserve, inability to tolerate surgery, and patient preference. Cryoablation is a minimally invasive therapy utilized for treating hepatic neoplasms by subjecting them to extreme cold temperatures. The "thermal sink" effect describes cryoablation near flowing blood such as that found in high volumes within major vascular structures. Thermodynamics dictates that proximity to the flowing intravascular compartment will decrease ice formation, and therefore, tumor destruction.

Methods: This report describes a novel palliative technique to induce temporary cessation of the blood flow in the intrahepatic inferior vena cava (IVC), thus enabling the operator to perform cryoablation targeting invasive cancer within.

Results: Adequate ablation using this technique allowed a patient with IVC invasion 9 months of survival.

Conclusion: Quality of life during this time was maximized, as recovery time from this procedure is minimal.

Background/aims: Anatomical variations are frequently encountered during hepato-biliary-pancreatic surgeries, requiring surgeons to have a precise understanding of the surgical anatomy in order to perform a safe surgery. We evaluated the impact of novel three-dimensional (3D) surgical simulation on pancreatic surgeries to enhance surgical residents' understanding.

Methodology: Between January 2013 and May 2014, 61 preoperative 3D surgical simulations were performed. The consistency (0-10, with 10 representing 100% consistency) among the 15 surgical residents' anatomical drawings from multidetector computed tomography images and the simulated 3D images by SYNAPSE VINCENT® was assessed. We divided the surgical residents into two groups - first- to fifth-year postgraduate doctors (group A) and sixth- to tenth-year postgraduate doctors (group B) - and compared the self-assessment scores between these two groups.

Results: In terms of the self-assessment scores, a statistically significant difference was observed between the two groups (p < 0.001).

Conclusions: In this study, 3D surgical simulation was useful for preoperative assessments prior to pancreatic surgery, especially in younger postgraduate surgeons.

Background: Immunonutrition (IN) significantly reduces the incidence of postoperative infectious complications and the length of hospitalization in patients undergoing major elective surgery for gastrointestinal malignances. However, the clinical benefit of IN in patients who have undergone esophagectomy for esophageal cancer is unclear. Moreover, the effect of enteral IN in patients during preoperative adjuvant chemoradiotherapy and in patients treated with concurrent chemoradiotherapy for advanced esophageal cancer is unknown.

Summary: This review analyzes the evidence supporting the enteral administration of IN in patients who have undergone esophagectomy and/or chemoradiotherapy for esophageal cancer. Twelve trials that evaluated IN exclusively in patients who underwent esophagectomy were published between January 1980 and August 2017. Two trials concerning IN during chemoradiotherapy for esophageal cancer were identified in the same period. However, the evidence is insufficient to recommend enteral IN in patients who have undergone esophagectomy and/or chemoradiotherapy for esophageal cancer.

Key message: Further evidence from well-designed randomized controlled trials is required to verify the clinical benefits of enteral IN in patients undergoing esophagectomy and/or chemoradiotherapy for esophageal cancer.

Practical implications: Resolvins, which are generated from EPA, are novel anti-inflammatory lipid mediators and may play a key role in the resolution of acute inflammation when IN is supplemented with EPA in patients undergoing severely stressful operations.

Background/aims: The International Study Group of Pancreatic Surgery recently published a consensus statement on the definition of extended pancreatectomy (EP). We aimed to determine the safety profile and short-term outcomes of EP compared to standard pancreatectomy (SP). To mitigate surgeon bias, only pancreatectomies performed by a single surgeon were included.

Methods: Ninety consecutive patients who underwent pancreatectomy by a single surgeon over a period of 5 years and who met our study criteria were classified into an SP or an EP group. Sixty-two patients underwent pancreaticoduodenectomy (PD), including total pancreatectomy, and 28 patients underwent distal pancreatectomy.

Results: The 25 patients who underwent EP had significantly increased operation time, estimated blood loss, postoperative intensive care unit (ICU) transfer, and postoperative stay compared to the 65 patients who underwent SP. There was 1 (1.1%) 30-day mortality and 4 (4.4%) in-hospital mortalities. Postoperative morbidity and mortality were similar between both groups. Subgroup analysis of the patients who underwent PD demonstrated that the EP group (n = 22) had significantly increased operation time and postoperative ICU transfers.

Conclusion: Although patients who underwent EP experienced significantly increased operative time, blood loss, and postoperative stay, they did not experience significantly higher postoperative morbidity or mortality compared to patients who underwent SP.

Background: Neoadjuvant chemoradiotherapy (CRT) is considered the standard approach before any surgical intervention for locally advanced rectal tumors and has been proven to significantly improve the local recurrence rates of rectal cancer. However, the optimal timing of surgical resection after neoadjuvant CRT remains debatable.

Objective and methods: We conducted a retrospective review of 65 consecutive patients with locally advanced rectal cancer who underwent preoperative CRT followed by surgical resection in order to evaluate the optimal time for surgical treatment. We used two alternative groups for analysis: patients who underwent surgery up to 6 weeks after CRT (n = 28) and those who underwent surgery 6 weeks or more after CRT (n = 27). Also, we compared patients who were operated on within 3 months (n = 39) with those who underwent surgical resection after more than 3 months (n = 16). Nonresponders to CRT were excluded from the analysis.

Results: There was no statistically significant association between waiting period post CRT and radiological downstaging for any group (p > 0.05 for any association). Also, there was no association between recurrence of disease, cancer-related deaths, perineural invasion, or positive lymph node ratio and any waiting period up to 3 months (p > 0.05 for all associations).

Conclusion: In this small exploratory study there was no evident difference in outcome according to timing of surgery, which suggests that further research in larger cohorts is warranted.

[This corrects the article DOI: 10.1159/000442831.].