bluuebunny/crossref_metadata_2025_split huggingface dataset:
Staging of gastric cancer: Comparison of post-operative pathologic staging to pre-operative CT and endoscopic ultrasonographic staging.
Authors: Jung Sung Min , Cheung Dae Young , Kim Jin Il , Kim Jae J. , Lee Sang Woo , Jung Hyun Chae 
Published: February 2017

11 Background: Stomach CT and endoscopic ultrasonography are used for evaluating pre-operative staging of gastric cancer. The aim of this study was to compare the pre-operative CT and endoscopic ultrasonographic staging to post-operative pathologic staging. Methods: We reviewed medical records of 567 patients with gastric cancer from 2012 to 2015, and compared their pre-operative CT staging to post-operative pathologic staging. Among the 567 patients, 149 patients underwent pre-operative endoscopic ultrasonographic staging, so we compared their pre-operative endoscopic ultrasonographic staging to post-operative pathologic staging. We also investigated lymph node metastasis in 146 patients with gastric cancer invading submucosa, planning to undergo endoscopic submucosal dissection. Results: The numbers of patients diagnosed as T1, T2, T3, T41, and T4b by pre-operative CT staging were 327, 97, 93, 46, and 4, respectively. However, the numbers of patients diagnosed as T1, T2, T3, T41, and T4b by post-operative pathologic staging were 208, 153, 53, 83, 62, and 8, resulting the pre-operative CT staging to be under-estimated. Similarly, pre-operative endoscopic ultrasonographic staging was also under-estimated, as although 48, 67, 32, and 2 patients were diagnosed as T1a, T1b, T2, and T3, respectively, by the pre-operative endoscopic ultrasonographic staging, post-operative pathologic staging revealed 72, 55, 13, 7, and 2 patients. In patients with gastric cancer invading submucosa (sm), there were 56 patients with sm1 invasion, 32 patients with sm2 invasion, and 91 patients with sm3 invasion. Lymph node metastasis was observed in 7 patients with sm1 invasion, 3 patients with sm2 invasion, and 22 patients with sm3 invasion. Poorly cohesive gastric cancer was the most common pathologic diagnosis in patients with metastatic lymph node. Conclusions: Physicians should keep in mind that pre-operative stomach CT and endoscopic ultrasonographic staging can be under-estimated compared to post-operative pathologic staging. Also, patients with poorly cohesive adenocarcinoma had more lymph node metastasis than patients with differentiated adenocarcinoma.
Endoscopic stenting for esophageal leak after minimally invasive esophagectomy.
Authors: Ernst Brenda , Ross Helen J. , Paripati Harshita , Pannala Rahul , Rule William G. , Ashman Jonathan Ben , Harold Kristi L. , Jaroszewski Dawn E. 
Published: February 2017

110 Background: Anastomotic leaks can occur after esophagectomy and optimal management after minimally invasive esophagectomy (MIE) is not well defined. We reviewed endoscopic management of leaks after MIE in patients undergoing trimodality therapy at Mayo Clinic Arizona. Methods: Records of patients undergoing MIE from November, 2006 to February, 2015 were reviewed after appropriate IRB approval. Results: 148 patients underwent MIE including 136 (91.8%) thoracic and 12 (8.1%) cervical anastomoses. Clinically significant anastomotic leaks were observed in 13 (8.8%) patients with 2 (16%) cervical and 11 (8%) thoracic anastomosis at a median of 6.1 days (0-14). 11 (11%) patients treated with neoadjuvant chemoradiotherapy experienced esophageal leak and 2 who did not receive chemoradiotherapy (4%). For treatment of anastomotic leaks, 10 patients underwent VATS with pleural space irrigation and chest tube replacement, and 11 patients underwent stent deployment at the anastomosis for repair. Stents were placed such that the fistula/leak was in the fully covered portion with the greater portion of the stent residing in the esophageal remnant. Stents were removed at a mean of 54 days (28-114). In 2 patients, overgrowth into the stent body required stent-in-stent placement (fully covered) with removal of both stents. Stents were successful at sealing all leaks. Conclusions: Leaks after MIE represent a small, but significant, morbidity in MIE. The majority can be managed by endoscopic stent placement. Stenting is an effective management tool for postoperative leaks in locally advanced esophageal malignancies.
Role of palliative resection in patients with incurable advanced gastric cancer unfit for chemotherapy.
Authors: Takagi Wataru , Tanizawa Yutaka , Omori Hayato , Nishiwaki Noriyuki , Fujiya Keiichi , Hirata Fumiko , Tatsubayashi Taichi , Honda Shinsaku , Hikage Makoto , Makuuchi Rie , Tokunaga Masanori , Bando Etsuro , Kawamura Taiichi , Terashima Masanori 
Published: February 2017

114 Background: Recently, REGATTA trial showed that debulking surgeries followed by chemotherapy did not improve survival outcomes compared to chemotherapy alone for incurable advanced gastric cancer (AGC). Therefore, the standard treatment for incurable AGC without emergent symptom is not gastrectomy plus chemotherapy but chemotherapy alone. However, in patients who are unfit for chemotherapy due to poor performance status (PS), age, or comorbid chronic diseases, the role of palliative gastrectomy remains controversial. The aim of this study is to determine the role of palliative resection in patients with incurable AGC unfit for chemotherapy. Methods: Two hundred and twelve gastric cancer patients having any cause of incurable factors and underwent palliative gastrectomy or bypass operation between November 2002 and December 2014 were enrolled. Of these 212 patients, 64 patients who did not receive any chemotherapy were divided into two groups; Gastrectomy group with 45 patients who underwent palliative gastrectomy (distal gastrectomy in 18, total gastrectomy in 27) and Bypass group with 19 patients who underwent gastrojejunostomy. Survival outcomes and clinicopathologic features were compared between the two groups. Results: The reasons why unfit for chemotherapy were age (15), patients’ refusal (14), poor PS (11), postoperative complications (11), comorbidity (10), disease progression (3). There was no significant difference of clinicopathologic features between the two groups such as, age (MAN; 74.1 vs 77.1, p = 0.198), gender (male/female: 37/8 vs 13/6, p = 0.321), and number of incurable factors 2 or more (51.1% vs 63.2%, p = 0.422) except for postoperative complications of C-D grade 3 or more (24.4% vs 0%, p = 0.025). Median survival time of Gastrectomy group and Bypass group were 154 days (95%CI: 124-253) and 86 days (95%CI: 71-166), respectively, and significantly longer in Gastrectomy group (p = 0.002). Conclusions: These results suggest that palliative gastrectomy may improve survival in patients with incurable advanced gastric cancer unfit for chemotherapy.
Follow-up data from a phase II study of adjuvant S-1/cisplatin chemotherapy followed by S-1 based chemoradiotherapy for advanced gastric cancer.
Authors: Shim Hyun-Jeong , Bae Woo Kyun , Hwang Jun-Eul , Park Young-Kyu , Ryu Seong-Yeop , Nam Taek-Keun , Chung Ik-Joo , Cho Sang-Hee ,   Oncology
Published: February 2017

116 Background: Surgery is the only possible curative treatment for gastric cancer. However, the high recurrence rate makes gastric cancer difficult to cure by surgery alone. The present study was conducted to evaluate the clinical outcomes and toxicity of adjuvant treatment, including S-1/cisplatin chemotherapy followed by radiotherapy with concurrent S-1. Methods: Patients with radically D2-resected adenocarcinoma of the stomach of stage IB–IV (M0) were eligible. Patients were treated with S-1 (40–60 mg depending on the patient’s body surface area) twice daily for 3 weeks and cisplatin (60 mg/m²) intravenously on day 1 every 5 weeks. Patients received CRT (45 Gy of radiation at 1.8 Gy/day, 5 days per week, for 5 weeks with the same dose of S-1 during radiation) followed by two additional cycles of S-1/cisplatin. The primary endpoint was the 3-year disease-free survival (DFS) rate; the secondary endpoints were the 3-year overall survival rate and toxicities. Results: Until May 2012, 46 patients were enrolled, and 34 (73.9%) completed the planned treatment. The median age was 53 years (range: 31–69 years), and the numbers of patients with stage IB, II, III and IV disease were 0, 17, 25 and 4, respectively. Grade 3–4 toxicities were as follows: neutropenia (28.2%), nausea (17.4%), vomiting (8.7%) and anorexia (15.2%). At the time of analysis, after a median follow-up period of 56.5 months (3.03–74.0 months), 16 recurrence events and 15 deaths were reported. The estimated 3-year DFS and survival rates were 65.2% and 76.1%, respectively. The most common site of recurrence was the peritoneum (n = 12). Conclusions: The results of this phase II study show that intensified adjuvant treatment with S-1/cisplatin chemotherapy and S-1-based chemoradiotherapy was effective in reducing disease recurrence. A randomized trial is needed to evaluate the role of the addition of radiation to chemotherapy in adjuvant treatment for gastric cancer. Clinical trial information: NCT01824004.
Long term results and patterns of recurrence from SCOPE 1: A phase II/III randomised trial of definitive chemoradiotherapy (dCRT) plus or minus cetuximab (dCRT+C) in esophageal cancer.
Authors: Mukherjee Somnath , Hurt Chris , Falk Stephen , Gollins Simon , Staffurth John , Ray Ruby , Bridgewater John A. , Cunningham David , Blazeby Jane M. , Roy Rajarshi , Maughan Tim , Griffiths Gareth , Crosby Tom David Lewis 
Published: February 2017

118 Background: One of the largest trials in dCRT for localised oesophageal cancer, SCOPE 1 tested the role of adding cetuximab to conventional dCRT, and showed that this was associated with greater toxicity and worse survival. Here we present the long-term outcomes. Methods: Phase II/III trial. Randomisation: cisplatin 60mg/m2 D1 and capecitabine 625mg/m2 daily D1-21 for 4 cycles with/without Cetuximab 400mg/m2 D1 followed by 250mg/m2weekly. RT: 50Gy in 25 fractions given concurrent with cycles 3 and 4. Recruitment: Feb 2008 - Feb 2012, when the IDMC recommended trial closure on the basis of futility. Results: 258 patients (dCRT = 129; dCRT+C = 129) were recruited from 36 centres. Median follow-up (IQR): 46.7 (36.0-49.0) months for all surviving pts. 65.1% (dCRT arm) and 69.8% (dCRT+C arm) of patients had died. Esophageal cancer was the cause in 82.1% and 86.7% of deaths respectively (p = 0.41). Median OS months (95% CI) was 34.5 (24.7-42.3) in dCRT and 24.7 (18.6-31.3) in dCRT+C (HR 1.25, p = 0.137); corresponding 3-year OS (95% CI) was 47.2% (38.2%-55.7%) and 37.6% (29.1%-46.0%). Median PFS (95% CI): 24.1 (15.3-29.9) and 15.9 (10.7-20.8) months respectively (HR1.28, p = 0.114). There was some evidence that local PFS (within RT field) was lower in the dCRT+C arm (HR1.38, p = 0.051). On multivariable analysis including treatment arm, Stage I-II ds (vs Stage III), full-dose RT and higher cisplatin dose intensity ( ≥ 75% vs < 75%) were associated with improved OS and PFS. Patterns of recurrence (n [%]) were similar in both arms (see table). In dCRT arm, 31/38 pts (81.6%) with local relapse within the RT field compared to 40/48 (83.3%) in the dCRT+C arm (p = 0.8). Conclusions: The mature analysis shows unprecedented survival in dCRT arm, comparable to surgical trials (e.g. 3-year OS % [95% CIs] in OE05: CF 39 [35, 44] and ECX 42 [37, 46], in OE02: 31 [27, 36]). OS inferiority of dCRT+C is no longer statistically significant. The lower PFS (within RT field) in the dCRT+C arm was consistent with the lower number of patients receiving full dose of RT in the dCRT+C arm. Clinical trial information: 47718479. [Table: see text]
Outcomes of esophagectomy in elderly patients with esophageal cancer: A population-based study.
Authors: Mikhail Sameh , Hinton Alice , Wuthrick Evan John , Perry Kyle , Merritt Robert , Williams Terence M , Conwell Darwin , Bekaii-Saab Tanios S. , Krishna Somashekar 
Published: February 2017

121 Background: Studies evaluating the outcome of esophectomy (Esx) in elderly patients (pts) with esophageal cancer (EC) have showed conflicting results. Surgical techniques in Esx have advanced significantly in the last decade. Our study evaluates national trends and outcomes of Esx in elderly pts. Methods: Our analysis includes adult pts aged < 70, 70-79 and > 79 in the Nationwide Inpatient Sample who underwent Esx 2002-2012. We examined temporal trends and performed multivariate analysis for key outcomes controlling for demographics, hospital factors and comorbidities. Results: Inpatient mortality was higher in pts aged > 79 (17%; OR 3.24, 95 CI 2.05, 5.12 N = 1,464) and pts 70-79 (9%; OR 1.44, 95% CI 1.01, 2.06; N = 7,393) compared to pts < 70 (5.26%; N = 20,730). Complication rates and length of stay were 76%, 73% and 64%, and 19.2, 18.4 and 17.1 days in the three age groups, respectively. Inpatient mortality improved significantly for all age groups over the study period (Table). Following Esx, 47%, 64% and 82% of pts aged > 79, 70-79 and < 70, were discharged home, respectively. Across all age groups, most pts (74.7%, 75.6 % and 79.4%, respectively) underwent Esx in urban teaching hospitals. On multivariate analysis for pts aged ≥ 70, rural nonteaching hospitals were associated with higher mortality compared to urban teaching hospitals (OR: 3.18, CI 1.47, 6.86). Complication rates were not significantly different between the two hospital settings. Mortality was higher with congestive heart failure (OR 1.86, 95% CI 1.08, 3.23), chronic lung disease (OR 1.91, CI 1.32, 2.76) and peripheral vascular disease (OR 2.41, CI 1.18, 4.92). Conclusions: Inpatient mortality following Esx has significantly improved over the last decade but remains high in elderly pts especially in nonteaching hospitals. Our data should aid multidisciplinary teams in counseling elderly pts about mortality risk of surgery. Further research is needed to better select elderly patients who will benefit from surgical resection. [Table: see text]
Response to neoadjuvant chemotherapy and impact on survival for resected gastric cancer.
Authors: Greenleaf Erin , Hollenbeak Christopher S , Wong Joyce 
Published: February 2017

122 Background: This study assesses the survival impact of perioperative chemotherapy, with further analysis of pathologic response to neoadjuvant chemotherapy (NAC), in patients undergoing gastrectomy for gastric cancer (GC) in a large US sample. Methods: Using the 2003-2012 ACS National Cancer Database, 16,128 patients underwent gastrectomy for cancer. Treatment groups were categorized as: NAC, adjuvant chemotherapy, and surgery only. Patients receiving NAC were further categorized as: down-staged, no response, and disease progression. Univariate and multivariate analyses were performed to estimate the impact of treatment on overall survival. Results: Of patients undergoing gastrectomy, 36.6% received NAC, 19.5% received adjuvant chemotherapy, and 43.9% underwent surgery only. Median time of survival was longer in patients with more advanced disease who underwent either NAC or adjuvant chemotherapy versus surgery alone (see Table). In multivariate analysis, patients who received NAC had 20% lower hazard of death than surgery only patients (HR = 0.80, p < 0.0001). Within the NAC cohort (N = 5,909), 47.7% were down-staged, 36.5% had no response, and 15.7% demonstrated disease progression. Having a pathologic response to NAC was associated with having private insurance (OR = 1.22, p < 0.0001), higher socioeconomic status (OR = 1.21, p = 0.003), treatment in the central US (p < 0.0001, both), and undergoing proximal gastrectomy (OR = 1.59, p < 0.0001). Among patients who received NAC, median time of survival was longer if NAC down-staged patients to stages 0 or 1, with no survival difference in advanced stage disease. Conclusions: Neoadjuvant chemotherapy elicits a survival benefit in patients with advanced GC. Pathologic response is achieved in nearly half of patients undergoing NAC and is associated with improved survival, although only when down-staging to early stage disease. [Table: see text] [Table: see text]
Timing of adjuvant chemotherapy and impact on survival for resected gastric cancer.
Authors: Greenleaf Erin , Hollenbeak Christopher S , Wong Joyce 
Published: February 2017

123 Background: Standard of care for patients with advanced gastric cancer includes administration of adjuvant chemotherapy (ADJ); however, post-operative convalescence often prolongs the interval between surgery and chemotherapy. This study assesses the survival impact of timing of adjuvant chemotherapy in patients undergoing resection for gastric cancer. Methods: The 2003-2012 ACS NCDB was analyzed for patients treated with gastrectomy for cancer. Treatment groups were stratified by time to initiation of ADJ. The categories included: initiation of chemotherapy within 3 months post-operatively, after 3 months post-operatively, and surgery only. Univariate and multivariate analyses were performed. Results: Of 10,242 patients undergoing gastrectomy, 31% received ADJ and 69% underwent surgery only. Median time to receipt of chemotherapy was 52 days. The majority, 87%, received ADJ within 3 months. 13% received ADJ after 3 months. Patients who received ADJ earlier were more frequently younger, female, privately insured, with fewer comorbidities, treated in comprehensive community facilities, and more often with stages II and III disease. In multivariate analysis, patients who received ADJ had a 36% less hazard of death, both with administration within 3 months post-operatively and later, compared to surgery only patients (HR = 0.64, p < 0.0001, both). Among patients who received ADJ within 3 months and after, median time of survival was not different at a statistically significant level, when stratified by pathologic stage (see Table). Median time of survival was longer for both chemotherapy cohorts when compared with surgery only, specifically in patients with pathologic stage II, III, and III disease. Conclusions: Time to initiation of adjuvant therapy following surgery does not impact survival. With improved survival over surgery only, even delayed initiation of chemotherapy should be offered, when appropriate. [Table: see text]
Transthoracic anastomotic leak after esophagectomy: Still a catastrophe?
Authors: McCarter Martin , Ryan Carrie , Meguid Robert , Paniccia Alessandro 
Published: February 2017

126 Background: Leaks from intrathoracic esophagogastric anastomosis are thought to be associated with higher rates of morbidity and mortality than leaks from cervical anastomosis. We challenge this assumption, and hypothesize that there is no significant difference in mortality based on the position of the esophagogastric anastomosis. Methods: A systematic literature search was conducted using PubMed and Embase databases on all studies published between January 2000 and June 2015 comparing transthoracic (TTE) and transhiatal (THE) esophagectomies. Studies that used alternate reconstruction approaches were excluded. Outcomes analyzed were leak rate, leak-associated mortality, overall 30-day mortality, and overall morbidity. Meta-analyses were performed using Mantel Haenszel statistical analyses on studies that reported on leak rates of both approaches. Nominal data are presented as frequency and interquartile range (IQR); measures of the association between treatments and outcomes are presented as odds ratio (OR) with 95% confidence interval (CI). Results: Twenty-one studies (including 3 randomized controlled trials) were included comprising of 7167 patients (54% TTE). THE approach yields a higher anastomotic leak rate (12%; IQR: 11.6% - 22.1%) than TTE (9.8%; IQR: 6.0% - 12.2%) (OR: 1.83 [0.34-06.92]), without any difference in leak-associated mortality (7.1% TTE vs. 4.6% THE; OR: 1.83, [0.39-8.52]). There was no difference in overall 30-day mortality (3.9% TTE vs. 4.3% THE; OR: 0.86, [0.66-1.13]) and morbidity (59.0% TTE vs. 66.6% THE; OR: 0.76, [0.37-1.59]). Conclusions: Transthoracic esophagectomy is associated with a lower leak rate and does not result in higher morbidity or mortality than transhiatal esophagectomy. The previously assumed higher rate of transthoracic leak-associated mortality is overstated, thus allowing surgeon discretion and other factors to influence the choice of intrathoracic versus cervical esophagogastric anastomosis.
A multinational phase II clinical trial of neoadjuvant imatinib for large gastrointestinal stromal tumor of the stomach.
Authors: Yang Han-Kwang , Kurokawa Yukinori , Ryu Min-Hee , Cho Haruhiko , Park Sook Ryun , Masuzawa Toru , Lee Hyuk-Joon , Matsumoto Sohei , Kwon Oh Kyoung , Honda Hiroshi , Lee Kyung Hee , Yamamoto Kazuyoshi , Kong Seong-Ho , Ishikawa Takashi , Yook Jeong Hwan , Nabeshima Kazuhito , Hahn Seokyung , Shimokawa Toshio , Kang Yoon-Koo , Nishida Toshirou 
Published: February 2017

130 Background: Neoadjuvant therapy is expected to reduce the risk of primary surgery, such as rupture of the tumor, hemorrhage, and multi-visceral resection, and to improve survivals for patients with a large gastric gastrointestinal stromal tumor (GIST). This study aims to evaluate the efficacy and safety of neoadjuvant imatinib therapy for a large gastric GIST. Methods: Patients with gastric GIST, which is 10cm or larger and without metastasis, received neoadjuvant imatinib (400mg/day) for 6 months, and up to 9 months if maximal response is expected. Postoperative adjuvant imatinib was prescribed for at least 1 year and up to 3 years according to adjuvant treatment guideline. The primary endpoint was complete (R0) resection rate. A primary analysis were performed by the time all the operations were finished, to examine the efficacy and safety of the neoadjuvant treatment. Results: Between Feb 2010 and Sep 2014, 55 patients were enrolled in Japan and Korea. One patient with a jejunal GIST and one patient with PDGFRA-18 D842V mutation were excluded from analysis. Mean tumor diameter was 12cm (10-23). 86.8% of patients (46/53) completed neoadjuvant treatment. Dose reduction of imatinib was performed in 26.4% (14/53). The most frequent Grade 3 or 4 adverse events were G3 rash (5/53, 9.4%) and G3/4 neutropenia (4/53, 7.5%). Disease control rate (PR+SD) and response rate (PR) of neoadjuvant imatinib was 100% and 62.3% by RECIST, and 100% and 98.1% by Choi criteria, respectively. There was no case of CR or PD. 50 patients underwent operation, and R0 resection rate was 90.6% (n = 48, 95% CI 79.3% - 96.9%), which was significantly higher than the threshold value of 70% (p < 0.001). Combined resection of other organs (except gall bladder) was performed in 24.5% (n = 13), and 83.0% of patients (n = 44) could preserve ≥ 50% of the stomach. Postoperative complication occurred in 18.0% (9/50). Conclusions: Neoadjuvant imatinib treatment is effective and safe treatment option for a large primary GIST allowing high R0 resection rate with acceptable incidence of adverse events and postoperative complications. Clinical trial information: UMIN000003114.