1,721,072 research outputs found
L’ espressione di BIRC3 come predittore di resistenza alla chemioradioterapia neoadiuvante nell’adenocarcinoma del cardias e nel carcinoma squamoso dell’esofago
No full textNell'ottica di un tailored treatment nella gestione delle malattie neoplastiche dell'esofago abbiamo valutato la possibilità di identificare un marcatore molecolare di risposta alla terapia. L’espressione di BIRC3 regolata da TAK1 potrebbe essere responsabile della resistenza alla chemio-radioterapia neoadiuvante nel trattamento dell’adenocarcinoma dell’esofago e della giunzione esofago-gastrica (EGJ) mentre non pare avere un ruolo rilevante nei carcinomi squamocellulari.As part of a tailored treatment in the management of neoplastic diseases of the esophagus, we evaluated the possibility to identify a molecular marker of response to therapy. The expression of BIRC3 regulated by TAK1 may be responsible for resistance to neoadjuvant chemo-radiotherapy in the treatment of the esophageal and esophageal-gastric junction (EGJ) adenocarcinoma and does not seem to have a major role in squamous cell carcinomas
Predictors of anastomotic leak and conduit necrosis after oesophagectomy: Results from the oesophago-gastric anastomosis audit (OGAA)
No full textBackground: Both anastomotic leak (AL) and conduit necrosis (CN) after oesophagectomy are associated with high morbidity and mortality. Therefore, the identification of preoperative, modifiable risk factors is desirable. The aim of this study was to generate a risk scoring model for AL and CN after oesophagectomy. Methods: Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018-December 2018. Definitions for AL and CN were those set out by the Oesophageal Complications Consensus Group. Univariate and multivariate analyses were performed to identify risk factors for both AL and CN. A risk score was then produced for both AL and CN using the derivation set, then internally validated using the validation set. Results: This study included 2247 oesophagectomies across 137 hospitals in 41 countries. The AL rate was 14.2% and CN rate was 2.7%. Preoperative factors that were independent predictors of AL were cardiovascular comorbidity and chronic obstructive pulmonary disease. The risk scoring model showed insufficient predictive ability in internal validation (area under the receiver-operating-characteristic curve [AUROC] = 0.618). Preoperative factors that were independent predictors of CN were: body mass index, Eastern Cooperative Oncology Group performance status, previous myocardial infarction and smoking history. These were converted into a risk-scoring model and internally validated using the validation set with an AUROC of 0.775. Conclusion: Despite a large dataset, AL proves difficult to predict using preoperative factors. The risk-scoring model for CN provides an internally validated tool to estimate a patient's risk preoperatively
Postoperative anaemia increases unplanned readmission: an international prospective cohort study of patients undergoing major abdominal surgery
No full textPostoperative anaemia increases unplanned
readmission: an international prospective cohort study
of patients undergoing major abdominal surger
ASO Author Reflections: Recurrence After Pathological Complete Response in Esophageal Cancer: Analysis of Risk Factors for this Unexpected Event
No full textASO Author Reflections: Recurrence After Pathological Complete Response in Esophageal Cancer: Analysis of Risk Factors for this Unexpected Even
Treatment of esophago-gastric junction adenocarcinoma
No full textAIM: The incidence of Adenocarcinoma of the esophagogastric junction (EGJ) is increasing and its treatment is still debated, primarily because of the non-uniform definition of EGJ. MATERIALS AND METHODS: The most used classification of EGJ cancer was proposed by Siewert and it divides the EGJ in three regions: from 5 to I cm above the Z line (Siewert type I or esophageal Adenocarcinoma), from 1 over to 2 below the Z line (Siewert type II or real Cardia cancer) and from 2 below to 5 below the Z line (Siewert type III or proximal Gastric cancer diffused to Cardia). The neoplasia is defined type I, II or III depending on where is the center of the cancer. DISCUSSION: This classification did not show to be related to differences in prognosis and survival, but it has been used to guide the surgical strategy based on the site of the tumor. Criticism about this classification focuses mainly on the non-uniform treatment, in the current literature, of Siewert Type II cancer. CONCLUSION: From January 2010, a new definition of EGJ carcinoma has been introduced by TNM. This new de nition considers esophageal cancers all the ones whose centers falls inside a line drawn 5 cm below the Z line with invasion of the esophagus. This means that Siewert type I and II are now considered esophageal cancers, while type III can be esophageal or proximal gastric cancer depending if the esophagus is infiltrated or not. Criticism about this new definition rises on the border-line definition of former Siewert type III cancers
RAMIE: tradition drives innovation-feasibility of a robotic-assisted intra-thoracic anastomosis
No full textDue to the difficulties in the intra-thoracic esophagogastric anastomosis creation, totally minimally invasive Ivor Lewis esophagectomy (MIE) did not encountered a large diffusion, preferring hybrid techniques or cervical anastomosis. Robot-assisted minimally invasive esophagectomy (RAMIE) has gained popularity due to an easy reproducibility of the open anastomotic technique. In this feasibility study, we described the RAMIE technique introduced in our Center, providing innovative details for a mechanical end-to-end anastomosis. With patient in prone position, esophagectomy is conducted through the meso-esophagus plan. Robotic hand-sewn purse-string is realized above Azygos vein. A 4-cm thoracotomy in the fifth intercostal space is performed by enlarging the trocar incision. The tubulization is performed to create an access pouch for the introduction of the circular stapler. After the creation of the end-to-end anastomosis, the access pouch is resected and a robotic over-sewn is realized. From January 2020 until July 2020, ten patients were enrolled. No restriction in term of age, BMI, ASA grade or previous surgery were applied. Median operative time was 700min. R0 resection was achieved in all cases with a good lymph node harvesting. No anastomotic leak or stricture were observed. One chyle leak was treated conservatively. Median length of stay was 8days and 90days mortality was 0%. This study evidenced how robotic surgery allowed us to perform the same anastomosis of our open technique with good oncological results and morbidity and length of stay comparable with our previous results. Of note, longer operative time has been recorded. Further studies after the completion of the learning curve are necessary to address more definite conclusions
Adenocarcinoma of the esophagogastric junction; going up or down?
No full textLetter to the editor: what is Cardiac cancer: stomach or Esophagu
Adenocarcinoma of the esophagogastric junction
No full textEsophagogastric junction (EGJ) cancer is, among solid cancers, the fastest growing tumor in terms of incidence in Western countries, and due to the lifestyle changes in developing and newly industrialized countries, this trend is expected to intensify worldwide. EGJ adenocarcinoma, however, is poorly defined: first because it is not an “organ disease” but a “zone disease,” and also because among EGJ cancers there can be included different diseases with different etiology and different biology. Eastern countries, led by Japan, taught us the correct management of gastric cancer and provided us guide- lines for the treatment of esophageal squamous cell carcinoma. However when we talk about EGJ adenocarcinoma, it is a separate entity and is more properly a Western reality; therefore, Western countries should systematize and give answers to the relevant issues this cancer raises, along the road to standardization. Europe has been leading the evolution of thought on EGJ carcinoma, especially thanks to Siewert and the German school, which cre- ated the classification that still is used as a guide by clinicians in therapeutic strategy planning. With the introduction of the latest version of the TNM, all EGJ cancers were defined as esophageal cancers, suggesting the possibility of a uniform treatment. In the era of tailored treatment and targeted therapy, we may wonder if what we already have is enough or if we need to go further on, especially considering the lack of homogeneity in the choice of multi- modal treatments according only to topography. I then decided that it was still necessary to concentrate just on this difficult cancer and, together with my co-workers Simone Giacopuzzi and Andrea Zanoni, I decided to write a book, which we hope will shed a little light on such a complex and current topic. To make this book more international, I invited to participate, in order to give their significant key to interpretation, also some surgeons of renowned importance in the field. I would like to thank them all deeply for their contributions. Based on the experience of the Italian Research Group for Gastric Cancer (GIRCG) and the European Chapter of IGCA, we hope that this collaboration will start to build an even closer international cooperation with the opportu- nity to create a European network on EGJ adenocarcinoma
Is a robot surgeon with AI the ideal surgeon? A philosophical analysis
Full text linkThe medical field of surgery has integrated robots with Artificial Intelligence into its procedures. Currently, these machines primarily assist physicians in their activities, but it is plausible that, with ongoing scientific and technological advancements, AI robot surgeons could replace human surgeons in the near future. After providing an overview of the current state of robotic surgery and prospective future developments and scenarios, the paper will focus on the potential difficulties patients may experience in accepting interventions performed by an AI robot surgeon, largely owing to their perception of the robot as non-human. The prevailing concerns that will be analyzed and discussed from a philosophical standpoint include the belief that the AI robotic surgeon is not considered part of the medical team, its perceived incapacity to empathize with patients and to create emotional involvement, and the fear that it might commit severe errors unanticipated by its programming or react inappropriately to adverse events
Cutoff values of major surgical complications rates after gastrectomy
No full textGastric cancer is one of the most frequent cancers worldwide, and surgical resection remains the mainstay of the therapeutic pathway. Gastrectomy for cancer is still performed in many hospitals, and centralization remains limited to a small number of health systems. Morbidity and mortality after surgery for gastric cancer are surprisingly high. However, while mortality is obviously defined, major morbidity definitions still present some critical points. The aim of this study is to underline the need for universally accepted definitions of major complications and to describe the research agenda of a multicenter, European-based, prospective project launched by the European Chapter of the International Gastric Cancer Association (IGCA), with the goal of providing a list of complications related to gastrectomy for cancer with their definitions
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