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Berlin Brandenburg

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  • Esophageal Cancer
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  • 1
    Language: English
    In: Expert Review of Anticancer Therapy, 01 April 2011, Vol.11(4), pp.571-578
    Description: There has been much recent debate regarding the best surgical procedure to treat esophageal cancer, in particular with regard to the optimum extent of lymphadenectomy to improve survival while minimizing morbidity. No results obtained by prospective, randomized studies on the comparison of...
    Keywords: Esophageal Cancer ; Individualized Lymph Node Dissection Strategies ; Limited Resection and Limited Lymphadenectomy ; Lymph Node Metastasis ; Minimally Invasive Esophagectomy ; Neoadjuvant Therapy ; Three-Field/Two-Field Lymphadenectomy ; Medicine
    ISSN: 1473-7140
    E-ISSN: 1744-8328
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  • 2
    Language: English
    In: Expert Review of Anticancer Therapy, 01 September 2010, Vol.10(9), pp.1345-1347
    Keywords: Endoscopic Resection ; Endoscopic Submucosal Dissection ; Radical Oncologic Surgery ; Superficial Esophageal Cancer ; Medicine
    ISSN: 1473-7140
    E-ISSN: 1744-8328
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  • 3
    Language: English
    In: Expert Review of Anticancer Therapy, 01 April 2011, Vol.11(4), pp.601-612
    Description: Lymph node status is the most important single prognostic factor in esophageal cancer. The detection of involved lymph nodes is therefore the key to cure. This article will provide a meta-analysis and metaregression analysis on the diagnostic performances of current lymph node-detection devices;...
    Keywords: Esophageal Cancer ; Imaging Devices ; Lymph Node Metastasis ; Meta-Analysis ; Micrometastasis ; Molecular Markers ; Sentinel Lymph Node Navigation ; Systematic Review ; Medicine
    ISSN: 1473-7140
    E-ISSN: 1744-8328
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  • 4
    Language: English
    In: BMC Cancer, Feb 15, 2012, Vol.12, p.70
    Description: Background Our aim was to compare survival of the various treatment modality groups of chemotherapy and/or radiotherapy in relation to SEMS (self-expanding metal stents) in a retrospective case-control study. We have made the hypothesis that the administration of combined chemoradiotherapy improves survival in inoperable esophageal cancer patients. Methods All patients were confirmed histologically as having surgically non- resectable esophageal carcinoma. Included were patients with squamous cell carcinoma, undifferentiated carcinoma as well as Siewert type I--but not type II - esophagogastric junctional adenocarcinoma. The decision to proceed with palliative treatments was taken within the context of a multidisciplinary team meeting and full expert review based on patient's wish, co-morbid disease, clinical metastases, distant metastases, M1 nodal metastases, T4-tumor airway, aorta, main stem bronchi, cardiac invasion, and peritoneal disease. Patients not fit enough to tolerate a radical course of definitive chemo- and/or radiation therapy were referred for self-expanding metal stent insertion. Our approach to deal with potential confounders was to match subjects according to their clinical characteristics (contraindications for surgery) and tumor stage according to diagnostic work-up in four groups: SEMS group (A), Chemotherapy group (B), Radiotherapy group (C), and Chemoradiotherapy group (D). Results Esophagectomy was contraindicated in 155 (35.5%) out of 437 patients presenting with esophageal cancer to the Department of General and Abdominal Surgery of the University Hospital of Mainz, Germany, between November 1997 and November 2007. There were 133 males and 22 females with a median age of 64.3 (43-88) years. Out of 155 patients, 123 were assigned to four groups: SEMS group (A) n = 26, Chemotherapy group (B) n = 12, Radiotherapy group (C) n = 23 and Chemoradiotherapy group (D) n = 62. Mean patient survival for the 4 groups was as follows: Group A: 6.92 [+ -] 8.4 months; Group B: 7.75 [+ -] 6.6 months; Group C: 8.56 [+ -] 9.5 months, and Group D: 13.53 [+ -] 14.7 months. Significant differences in overall survival were associated with tumor histology (P = 0.027), tumor localization (P = 0.019), and type of therapy (P = 0.005), respectively, in univariate analysis. Treatment modality (P = 0.043) was the only independent predictor of survival in multivariate analysis. The difference in overall survival between Group A and Group D was highly significant (P [less than] 0.01) and in favor of Group D. As concerns Group D versus Group B and Group D versus Group C there was a trend towards a difference in overall survival in favor of Group D (P = 0.069 and P = 0.059, respectively). Conclusions The prognosis of inoperable esophageal cancer seems to be highly dependent on the suitability of the induction of patient-specific therapeutic measures and is significantly better, when chemoradiotherapy is applied.
    Keywords: Chemotherapy -- Health Aspects ; Chemotherapy -- Patient Outcomes ; Chemotherapy -- Comparative Analysis ; Esophageal Cancer -- Care And Treatment ; Esophageal Cancer -- Patient Outcomes ; Esophageal Cancer -- Research ; Radiotherapy -- Health Aspects ; Radiotherapy -- Patient Outcomes ; Radiotherapy -- Comparative Analysis
    ISSN: 1471-2407
    Source: Cengage Learning, Inc.
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  • 5
    Language: English
    In: BMC Cancer, Feb 15, 2012, Vol.12, p.70
    Description: Background Our aim was to compare survival of the various treatment modality groups of chemotherapy and/or radiotherapy in relation to SEMS (self-expanding metal stents) in a retrospective case-control study. We have made the hypothesis that the administration of combined chemoradiotherapy improves survival in inoperable esophageal cancer patients. Methods All patients were confirmed histologically as having surgically non- resectable esophageal carcinoma. Included were patients with squamous cell carcinoma, undifferentiated carcinoma as well as Siewert type I--but not type II - esophagogastric junctional adenocarcinoma. The decision to proceed with palliative treatments was taken within the context of a multidisciplinary team meeting and full expert review based on patient's wish, co-morbid disease, clinical metastases, distant metastases, M1 nodal metastases, T4-tumor airway, aorta, main stem bronchi, cardiac invasion, and peritoneal disease. Patients not fit enough to tolerate a radical course of definitive chemo- and/or radiation therapy were referred for self-expanding metal stent insertion. Our approach to deal with potential confounders was to match subjects according to their clinical characteristics (contraindications for surgery) and tumor stage according to diagnostic work-up in four groups: SEMS group (A), Chemotherapy group (B), Radiotherapy group (C), and Chemoradiotherapy group (D). Results Esophagectomy was contraindicated in 155 (35.5%) out of 437 patients presenting with esophageal cancer to the Department of General and Abdominal Surgery of the University Hospital of Mainz, Germany, between November 1997 and November 2007. There were 133 males and 22 females with a median age of 64.3 (43-88) years. Out of 155 patients, 123 were assigned to four groups: SEMS group (A) n = 26, Chemotherapy group (B) n = 12, Radiotherapy group (C) n = 23 and Chemoradiotherapy group (D) n = 62. Mean patient survival for the 4 groups was as follows: Group A: 6.92 [+ -] 8.4 months; Group B: 7.75 [+ -] 6.6 months; Group C: 8.56 [+ -] 9.5 months, and Group D: 13.53 [+ -] 14.7 months. Significant differences in overall survival were associated with tumor histology (P = 0.027), tumor localization (P = 0.019), and type of therapy (P = 0.005), respectively, in univariate analysis. Treatment modality (P = 0.043) was the only independent predictor of survival in multivariate analysis. The difference in overall survival between Group A and Group D was highly significant (P [less than] 0.01) and in favor of Group D. As concerns Group D versus Group B and Group D versus Group C there was a trend towards a difference in overall survival in favor of Group D (P = 0.069 and P = 0.059, respectively). Conclusions The prognosis of inoperable esophageal cancer seems to be highly dependent on the suitability of the induction of patient-specific therapeutic measures and is significantly better, when chemoradiotherapy is applied.
    Keywords: Chemotherapy -- Health Aspects ; Chemotherapy -- Patient Outcomes ; Chemotherapy -- Comparative Analysis ; Esophageal Cancer -- Care And Treatment ; Esophageal Cancer -- Patient Outcomes ; Esophageal Cancer -- Research ; Radiotherapy -- Health Aspects ; Radiotherapy -- Patient Outcomes ; Radiotherapy -- Comparative Analysis
    ISSN: 1471-2407
    Source: Cengage Learning, Inc.
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  • 6
    Language: English
    In: World journal of gastroenterology, 07 March 2013, Vol.19(9), pp.1424-37
    Description: To investigate potential therapeutic recommendations for endoscopic and surgical resection of T1a/T1b esophageal neoplasms. A thorough search of electronic databases MEDLINE, Embase, Pubmed and Cochrane Library, from 1997 up to January 2011 was performed. An analysis was carried out, pooling the effects of outcomes of 4241 patients enrolled in 80 retrospective studies. For comparisons across studies, each reporting on only one endoscopic method, we used a random effects meta-regression of the log-odds of the outcome of treatment in each study. "Neural networks" as a data mining technique was employed in order to establish a prediction model of lymph node status in superficial submucosal esophageal carcinoma. Another data mining technique, the "feature selection and root cause analysis", was used to identify the most important predictors of local recurrence and metachronous cancer development in endoscopically resected patients, and lymph node positivity in squamous carcinoma (SCC) and adenocarcinoma (ADC) separately in surgically resected patients. Endoscopically resected patients: Low grade dysplasia was observed in 4% of patients, high grade dysplasia in 14.6%, carcinoma in situ in 19%, mucosal cancer in 54%, and submucosal cancer in 16% of patients. There were no significant differences between endoscopic mucosal resection and endoscopic submucosal dissection (ESD) for the following parameters: complications, patients submitted to surgery, positive margins, lymph node positivity, local recurrence and metachronous cancer. With regard to piecemeal resection, ESD performed better since the number of cases was significantly less [coefficient: -7.709438, 95%CI: (-11.03803, -4.380844), P 〈 0.001]; hence local recurrence rates were significantly lower [coefficient: -4.033528, 95%CI: (-6.151498, -1.915559), P 〈 0.01]. A higher rate of esophageal stenosis was observed following ESD [coefficient: 7.322266, 95%CI: (3.810146, 10.83439), P 〈 0.001]. A significantly greater number of SCC patients were submitted to surgery (log-odds, ADC: -2.1206 ± 0.6249 vs SCC: 4.1356 ± 0.4038, P 〈 0.05). The odds for re-classification of tumor stage after endoscopic resection were 53% and 39% for ADC and SCC, respectively. Local tumor recurrence was best predicted by grade 3 differentiation and piecemeal resection, metachronous cancer development by the carcinoma in situ component, and lymph node positivity by lymphovascular invasion. With regard to surgically resected patients: Significant differences in patients with positive lymph nodes were observed between ADC and SCC [coefficient: 1.889569, 95%CI: (0.3945146, 3.384624), P 〈 0.01). In contrast, lymphovascular and microvascular invasion and grade 3 patients between histologic types were comparable, the respective rank order of the predictors of lymph node positivity was: Grade 3, lymphovascular invasion (L+), microvascular invasion (V+), submucosal (Sm) 3 invasion, Sm2 invasion and Sm1 invasion. Histologic type (ADC/SCC) was not included in the model. The best predictors for SCC lymph node positivity were Sm3 invasion and (V+). For ADC, the most important predictor was (L+). Local tumor recurrence is predicted by grade 3, metachronous cancer by the carcinoma in-situ component, and lymph node positivity by L+. T1b cancer should be treated with surgical resection.
    Keywords: Adenocarcinoma ; Controversies in Treatment ; Deep Third Submucosal Layer ; Dysplasia ; Endoscopic Gastrointestinal Surgery ; Endoscopic Gastrointestinal Surgical Procedures ; Endoscopic Resection ; Esophageal Cancer ; Lymph Node Dissection ; Lymphatic Invasion ; Middle Third Submucosal Layer ; Mucosal Infiltration ; Recurrent Tumor ; Squamous Cell Carcinoma ; Submucosal Involvement ; Submucosal Layer ; Superficial Esophageal Cancer ; Superficial Submucosal Layer ; Vascular Invasion ; Esophagoscopy ; Carcinoma -- Surgery ; Esophageal Neoplasms -- Surgery ; Esophagectomy -- Methods
    ISSN: 10079327
    E-ISSN: 2219-2840
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  • 7
    Language: English
    In: The Annals of Thoracic Surgery, November 2013, Vol.96(5), pp.1840-1845
    Description: There is an increasing trend to include patients with esophageal carcinoma invading the muscularis propria (pT2) in neoadjuvant therapy regimens. But it is unclear which patients have prognostic benefit from this strategy. The aim of this study was to assess the prognosis and prognostic factors in patients with pT2 esophageal adenocarcinoma to further optimize treatment strategies. Included were patients with pT2 esophageal adenocarcinoma treated operatively at three centers specializing in upper gastrointestinal surgery. There were 159 patients (139 male) without induction therapy; median age was 64.5 years. Survival was analyzed by univariate and multivariate analysis. In 37% of patients (n = 59), no lymph node involvement (pN0) was detected. Overall 5-year survival rate for all patients was 37%; for pN0 patients it was 62%, and for patients with lymph node metastases (pN+) it was 24%. Median number of examined lymph nodes was 26. Extracapsular lymph node involvement (ELNI) was evident in 55 of 100 pN+ patients with a 5-year survival rate of 14%. Patients without ELNI had a 5-year survival rate of 36% (  = 0.041). Results were comparable in all participating hospitals. Thirty-day and 90-day mortality rates of the entire collective were 2.6% and 3.8%, respectively. Multivariate analysis of prognosis revealed the lymph node ratio ( 〈 0.001) and the pN-ELNI category (  = 0.005) as significant parameters (pN0 hazard ratio 1 [reference]; pN+ without ELNI hazard ratio 2.2, 95% confidence interval: 1.2 to 3.8); pN+ with ELNI hazard ratio 2.5, 95% confidence interval: 1.5 to 4.5). The prognosis of patients with esophageal adenocarcinoma invading the muscularis propria without lymph node metastasis is very good. However, in this study, about 30% had extracapsular lymph node involvement, which reflects particularly aggressive biological tumor behavior.
    Keywords: 7;
    ISSN: 0003-4975
    E-ISSN: 1552-6259
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  • 8
    Language: English
    In: Annals of the New York Academy of Sciences, December 2018, Vol.1434(1), pp.254-273
    Description: Despite improvements in operative strategies for esophageal resection, anastomotic leaks, fistula, postoperative pulmonary complications, and chylothorax can occur. Our review seeks to identify potential risk factors, modalities for early diagnosis, and novel interventions that may ameliorate the potential adverse effects of these surgical complications following esophagectomy.
    Keywords: Anastomotic Leak ; Chylothorax ; Complications ; Esophageal Cancer ; Fistula ; Anastomotic Leak ; Lung Diseases ; Esophagectomy -- Adverse Effects ; Esophagus -- Surgery
    ISSN: 00778923
    E-ISSN: 1749-6632
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  • 9
    Language: English
    In: Expert Review of Gastroenterology & Hepatology, 01 June 2011, Vol.5(3), pp.371-384
    Description: Objectives: Endoscopic local procedures are increasingly applied in patients with superficial esophageal cancer as an alternative to radical oncologic resection. The objective of this article is to determine the risk of nodal metastases in submucosal (sm) esophageal cancer, comparing the two...
    Keywords: Risk of Lymph Node Metastasis ; Sm1 ; Sm2 ; Sm3 ; Submucosal Depth of Tumor Infiltration ; Submucosal Esophageal Cancer ; Surgically Resected Specimens ; Medicine
    ISSN: 1747-4124
    E-ISSN: 1747-4132
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  • 10
    Language: English
    In: Annals of Surgical Oncology, 2013, Vol.20(7), pp.2428-2433
    ISSN: 1068-9265
    E-ISSN: 1534-4681
    Source: Springer Science & Business Media B.V.
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