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  • br Diagnosis of EGJ cancer Extensive preoperative

    2018-11-12


    Diagnosis of EGJ cancer Extensive preoperative staging is essential for the correct selection of a suitable therapeutic strategy against EGJ cancer. Endoscopic ultrasonography (EUS) is the most accurate method for assessing the locoregional extent of eletriptan hydrobromide and EGJ carcinomas. The EUS accuracy rates for evaluating the T, N, and M stages are 73%, 80%, and 78%, respectively. EUS has thus become mandatory in the preoperative assessment of tumors located at the EGJ. However, EUS accuracy for staging EGJ cancer is lower in tumors spanning >5 cm. Predicting the pT category and local resectability using EUS is possible in 85% of patients. Furthermore, magnifying narrow-band imaging (NBI) of endoscopy can enable contrasting the surface structure and vascular architecture of the mucosa, thus facilitating the evaluation of mucosal features that correspond to their histology. The morphology of the intrapapillary capillary loop in EGJ cancer, as observed through NBI magnification, varies according to the tumor invasion depth. Furthermore, NBI magnification can provide valuable information for distinguishing EGJ neoplasia from non-neoplasia as well as identifying the extent of neoplasia. The assessment of peritoneal and abdominal metastases conducted using noninvasive imaging yields inaccurate results. Diagnostic laparoscopy is the most accurate tool for identifying the peritoneal tumor spread or liver metastases in 25% of patients with locally advanced EGJ tumors. Patients with locally advanced EGJ tumors who respond to induction chemotherapy or chemoradiotherapy (CRT) exhibit significantly improved survival compared with patients with no response. A systematic review evaluated long-term survival outcomes in patients with advanced esophageal and EGJ cancers using the predictive value of 18F-fluorodeoxyglucose positron emission tomography (18FDG-PET). 18FDG-PET efficiently predicts long-term outcomes compared with histopathological tumor responses. Early PET permits the identification of nonresponsive patients for earlier operation and the discontinuation of ineffective preoperative therapy, without a survival detriment. The use of early PET during preoperative chemotherapy is undergoing evaluation in a CALGB/Alliance trial (ClinicalTrials.gov identifier: NCT01333033).
    Treatment strategies for EGJ cancer
    Conclusion
    Introduction A cross-sectional study conducted in a rural Taiwanese village reported a 5.0% prevalence of gallstones, with a slight propensity for the female sex. Risk factors for gallstone disease in both sexes included age and fatty liver. In females, diabetes mellitus, a history of gallstone disease in first-degree relatives, and the use of oral contraceptives were additional risk factors. Liu et al reported a 5.3% prevalence of gallstones in a Taiwanese population that had undergone a paid health examination. In their study, older age, higher body mass index, and type 2 diabetes mellitus were associated with an increased prevalence of gallstone disease. A higher incidence of gallstones has been reported in gastrectomy patients than in the general population. Wu et al reported cholelithiasis in 30% of patients receiving radical gastrectomy. The pathophysiology remains unclear, but the current theories posit that the surgical dissection of the vagal trunk affects gallbladder contractility and that a nonphysiological reconstruction of the gastrointestinal tract, such as duodenal exclusion, results in increased gallstone formation. The present study evaluated the incidence of gallstone formation after gastrectomy for stomach cancer and identified risk factors for gallstones.
    Methods In total, 657 patients had undergone gastrectomy with lymph node dissection between August 1996 and November 2010 at our cancer institute. Curative resection (R0) without microscopic or macroscopic residual diseases was achieved in 503 patients with Stage 0, I, or II cancer [pathologically staged according to the American Joint Committee on Cancer (AJCC) Staging Manual, 7Edition]. Patients with Stage III and IV cancer were excluded owing to poor survival and early recurrence. Moreover, patients with previous cholecystectomy or cholecystectomy combined with gastrectomy (n = 159); gallstones diagnosed preoperatively or within 6 months of gastrectomy (n = 29); previous partial gastrectomy (n = 7); a history of cholecystitis and obstructive jaundice (n = 3); and insufficient clinical data, imaging, and follow-up (n = 57) and those who underwent reconstruction methods other than Billroth I, Billroth II, Roux-en-Y, and uncut Roux-en-Y (n = 33), were excluded.