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Cancers
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Oesogastric Cancer: Treatment and Management
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Oesogastric Cancer: Treatment and Management

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 31 December 2024 | Viewed by 7774

Special Issue Editor

Dr. Arnaud Pasquer

E-Mail Website
Guest Editor
Service de Chirurgie Digestive, CHU Lyon, Lyon, France
Interests: treatment of small intestinal neuroendocrine tumors

Special Issue Information

Dear Colleagues,

Despite recent advances in the management of oesogastric cancers through the optimization of chemotherapy and radiotherapy protocols and surgical procedures, these cancers remain fatal in a large number of situations, with an average survival of 16% at 5 years. One-third of patients are operable at the time of diagnosis.

The main difficulties encountered remain the proper preoperative evaluation of patients in order not to ignore an indication for neoadjuvant treatment, but above all, the most prominent difficulty is the optimization of postoperative follow-up, with mortality rates ranging from 4 to 10% depending on the series published. In recent years, the development of minimally invasive surgery has mainly been reported in Asian series, whose populations differ in many aspects from other populations, making the results difficult to transpose. Finally, the management of peritoneal carcinosis in association with these cancers remains a major challenge in this constantly evolving field.

We are pleased to invite you to contribute to this Special Issue.

This Special Issue aims to show the precise impact of the most recent evolutions in terms of operative techniques in initial or recurrence settings, for example, the contribution of minimally invasive surgery—including thoracic approaches—on the quality of the lymph node resection, its extension, survival data, etc.

  • Investigate the possibilities of improving the postoperative course in vulnerable patients by medical of interventional perioperative optimization according to comorbidities.
  • Describe the surgical possibilities, novelties, and limits in the situation of peritoneal carcinosis.
  • Evaluate the contribution of new chemotherapy/immunotherapy/radiotherapy protocols.
  • Explore the management of complete responders.

I look forward to receiving your contributions.

Dr. Arnaud Pasquer
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • oesophagus cancer
  • gastric cancer
  • laparoscopy
  • robotic surgery
  • neoadjuvant treatment
  • immunotherapy
  • carcinosis
  • HIPEC
  • PIPAC

Published Papers (5 papers)

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Research

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15 pages, 2016 KiB  
Article
Quality of Life, Sarcopenia and Nutritional Status in Patients with Esophagogastric Tumors before and after Neoadjuvant Therapy
by Lena Schooren, Grace H. Oberhoff, Alexander Koch, Andreas Kroh, Tom F. Ulmer, Florian Vondran, Jan Bednarsch, Ulf P. Neumann, Sophia M. Schmitz and Patrick H. Alizai
Cancers 2024, 16(6), 1232; https://doi.org/10.3390/cancers16061232 - 21 Mar 2024
Viewed by 653
Abstract
(1) Background: Health-related quality of life (HRQoL) gains importance as novel treatment options for individuals with esophagogastric tumors to improve long-term survival. Impaired HRQoL has been shown to be a predictor of overall survival. Sarcopenia is a known prognostic factor for postoperative complications. [...] Read more.
(1) Background: Health-related quality of life (HRQoL) gains importance as novel treatment options for individuals with esophagogastric tumors to improve long-term survival. Impaired HRQoL has been shown to be a predictor of overall survival. Sarcopenia is a known prognostic factor for postoperative complications. As the regular control of sarcopenia through CT scans might not always be possible and HRQoL and nutritional scores are easier to obtain, this study aimed to assess the relationship between nutritional scores, HRQoL and skeletal muscle mass in patients undergoing chemotherapy for cancers of the upper gastrointestinal tract. (2) Methods: Eighty patients presenting with tumors of the upper GI tract were included and asked to fill out the standardized HRQoL questionnaire, EORTC’s QLQ-C30. Nutritional status was assessed using the MNA, MUST and NRS 2002 scores. Sarcopenia was determined semi-automatically based on the skeletal muscle index at the L3 vertebrae level in staging CT scans. (3) Results: In chemo-naïve patients, HRQoL summary scores correlated significantly with nutritional scores and SMI. SMI and HRQoL prior to neoadjuvant therapy correlated significantly with SMI after treatment. (4) Conclusions: HRQoL is a helpful tool for assessing patients’ overall constitution. The correlation of HRQoL summary scores and SMI might allow for a rough assessment of skeletal muscle status through HRQoL assessment in chemo-naïve patients. Full article
(This article belongs to the Special Issue Oesogastric Cancer: Treatment and Management)
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13 pages, 272 KiB  
Article
Robotic-Assisted Ivor Lewis Esophagectomy Is Safe and Cost Equivalent Compared to Minimally Invasive Esophagectomy in a Tertiary Referral Center
by Sebastian Knitter, Max M. Maurer, Axel Winter, Eva M. Dobrindt, Philippa Seika, Paul V. Ritschl, Jonas Raakow, Johann Pratschke and Christian Denecke
Cancers 2024, 16(1), 112; https://doi.org/10.3390/cancers16010112 - 25 Dec 2023
Viewed by 638
Abstract
In recent decades, robotic-assisted minimally invasive esophagectomy (RAMIE) has been increasingly adopted for patients with esophageal cancer (EC) or cancer of the gastroesophageal junction (GEJ). However, concerns regarding its costs compared to conventional minimally invasive esophagectomy (MIE) have emerged. This study examined outcomes [...] Read more.
In recent decades, robotic-assisted minimally invasive esophagectomy (RAMIE) has been increasingly adopted for patients with esophageal cancer (EC) or cancer of the gastroesophageal junction (GEJ). However, concerns regarding its costs compared to conventional minimally invasive esophagectomy (MIE) have emerged. This study examined outcomes and costs of RAMIE versus total MIE in 128 patients who underwent Ivor Lewis esophagectomy for EC/GEJ at our department between 2017 and 2021. Surgical costs were higher for RAMIE (EUR 12,370 vs. EUR 10,059, p < 0.001). Yet, median daily (EUR 2023 vs. EUR 1818, p = 0.246) and total costs (EUR 30,510 vs. EUR 29,180, p = 0.460) were comparable. RAMIE showed a lower incidence of postoperative pneumonia (8% vs. 25%, p = 0.029) and a trend towards shorter hospital stays (15 vs. 17 days, p = 0.205), which may have equalized total costs. Factors independently associated with higher costs included readmission to the intensive care unit (hazard ratio [HR] = 7.0), length of stay (HR = 13.5), anastomotic leak (HR = 17.0), and postoperative pneumonia (HR = 5.4). In conclusion, RAMIE does not impose an additional financial burden. This suggests that RAMIE may be considered as a valid alternative approach for esophagectomy. Attention to typical cost factors can enhance postoperative care across surgical methods. Full article
(This article belongs to the Special Issue Oesogastric Cancer: Treatment and Management)
9 pages, 1230 KiB  
Article
Definitive Chemoradiation Associated with Improved Survival Outcomes in Patients with Synchronous Oligometastatic Esophageal Cancer
by Thomas Matoska, Anjishnu Banerjee, Aditya Shreenivas, Lauren Jurkowski, Monica E. Shukla, Elizabeth M. Gore, Paul Linsky, Mario Gasparri, Ben George, Candice Johnstone, David Johnstone and Lindsay L. Puckett
Cancers 2023, 15(9), 2523; https://doi.org/10.3390/cancers15092523 - 28 Apr 2023
Cited by 3 | Viewed by 1614
Abstract
Background: The study of oligometastatic esophageal cancer (EC) is relatively new. Preliminary data suggests that more aggressive treatment regimens in select patients may improve survival rates in oligometastatic EC. However, the consensus recommends palliative treatment. We hypothesized that oligometastatic esophageal cancer patients treated [...] Read more.
Background: The study of oligometastatic esophageal cancer (EC) is relatively new. Preliminary data suggests that more aggressive treatment regimens in select patients may improve survival rates in oligometastatic EC. However, the consensus recommends palliative treatment. We hypothesized that oligometastatic esophageal cancer patients treated with a definitive approach (chemoradiotherapy [CRT]) would have improved overall survival (OS) compared to those treated with a purely palliative intent and historical controls. Methods: Patients diagnosed with synchronous oligometastatic (any histology, ≤5 metastatic foci) esophageal cancer treated in a single academic hospital were retrospectively analyzed and divided into definitive and palliative treatment groups. Definitive CRT was defined as radiation therapy to the primary site with ≥40 Gy and ≥2 cycles of chemotherapy. Results: Of 78 Stage IVB (AJCC 8th ed.) patients, 36 met the pre-specified oligometastatic definition. Of these, 19 received definitive CRT, and 17 received palliative treatment. With a median follow-up of 16.5 months (Range: 2.3–95.0 months), median OS for definitive CRT and palliative groups were 90.2 and 8.1 months (p < 0.01), translating into 5-year OS of 50.5% (95%CI: 32.0–79.8%) vs. 7.5% (95%CI: 1.7–48.9%), respectively. Conclusions: Oligometastatic EC patients treated with definitive CRT benefited from that approach with survival rates (50.5%) that vastly exceeded historical standards of 5% at 5 years for metastatic EC. Oligometastatic EC patients treated with definitive CRT had significantly improved OS compared to those treated with palliative-only intent within our cohort. Notably, definitively treated patients were generally younger and with better performance status versus those palliatively treated. Further prospective evaluation of definitive CRT for oligometastatic EC is warranted. Full article
(This article belongs to the Special Issue Oesogastric Cancer: Treatment and Management)
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Review

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13 pages, 1779 KiB  
Review
Novel Multi-Modal Therapies and Their Prognostic Potential in Gastric Cancer
by Swathikan Chidambaram, Delia Cortés Guiral and Sheraz Rehan Markar
Cancers 2023, 15(12), 3113; https://doi.org/10.3390/cancers15123113 - 08 Jun 2023
Cited by 1 | Viewed by 1432
Abstract
Background: Gastric cancer has a poor prognosis and involves metastasis to the peritoneum in over 40% of patients. The optimal treatment modalities have not been established for gastric cancer patients with peritoneal carcinomatosis (GC/PC). Although studies have reported favourable prognostic factors, these have [...] Read more.
Background: Gastric cancer has a poor prognosis and involves metastasis to the peritoneum in over 40% of patients. The optimal treatment modalities have not been established for gastric cancer patients with peritoneal carcinomatosis (GC/PC). Although studies have reported favourable prognostic factors, these have yet to be incorporated into treatment guidelines. Hence, our review aims to appraise the latest diagnostic and treatment developments in managing GC/PC. Methods: A systematic review of the literature was performed using MEDLINE, EMBASE, the Cochrane Review, and Scopus databases. Articles were evaluated for the use of hyperthermic intraperitoneal chemotherapy (HIPEC) and pressurised intraperitoneal aerosolised chemotherapy (PIPAC) in GC/PC. A meta-analysis of studies reporting on overall survival (OS) in HIPEC and comparing the extent of cytoreduction as a prognostic factor was also carried out. Results: The database search yielded a total of 2297 studies. Seventeen studies were included in the qualitative and quantitative analyses. Eight studies reported the short-term OS at 1 year as the primary outcome measure, and our analysis showed a significantly higher OS for the HIPEC/CRS cohort compared to the CRS cohort (pooled OR = 0.53; p = 0.0005). This effect persisted longer term at five years as well (pooled OR = 0.52; p < 0.0001). HIPEC and CRS also showed a longer median OS compared to CRS (pooled SMD = 0.61; p < 0.00001). Three studies reporting on PIPAC demonstrated a pooled OS of 10.3 (2.2) months. Prognostic factors for longer OS include a more complete cytoreduction (pooled OR = 5.35; p < 0.00001), which correlated with a peritoneal carcinomatosis index below 7. Conclusions: Novel treatment strategies, such as HIPEC and PIPAC, are promising in the management of GC/PC. Further work is necessary to define their role within the treatment algorithm and identify relevant prognostic factors that will assist patient selection. Full article
(This article belongs to the Special Issue Oesogastric Cancer: Treatment and Management)
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11 pages, 509 KiB  
Review
A Global Perspective on Gastric Cancer Screening: Which Concepts Are Feasible, and When?
by Wladyslaw Januszewicz, Maryla Helena Turkot, Peter Malfertheiner and Jaroslaw Regula
Cancers 2023, 15(3), 664; https://doi.org/10.3390/cancers15030664 - 21 Jan 2023
Cited by 9 | Viewed by 2810
Abstract
Background: Gastric cancer (GC) remains the fifth most common cancer and the third most common cause of cancer-related death globally. In 2022, GC fell into the scope of the updated EU recommendations for targeted cancer screening. Given the growing awareness of the GC [...] Read more.
Background: Gastric cancer (GC) remains the fifth most common cancer and the third most common cause of cancer-related death globally. In 2022, GC fell into the scope of the updated EU recommendations for targeted cancer screening. Given the growing awareness of the GC burden, we aimed to review the existing screening strategies for GC in high-risk regions and discuss potentially applicable modalities in countries with low-to-intermediate incidence. Methods: The references for this Review article were identified through searches of PubMed with the search terms “gastric cancer”, “stomach cancer”, “Helicobacter pylori”, and “screening” over the period from 1995 until August 2022. Results: As Helicobacter pylori (H. pylori)-induced gastritis is the primary step in the development of GC, the focus on GC prevention may be directed toward testing for and treating this infection. Such a strategy may be appealing in countries with low- and intermediate- GC incidence. Other biomarker-based approaches to identify at-risk individuals in such regions are being evaluated. Within high-incidence areas, both primary endoscopic screening and population-based H. pylori “test-and-treat” strategies represent cost-effective models. Conclusions: Given the significant variations in GC incidence and healthcare resources around the globe, screening strategies for GC should be adjusted to the actual conditions in each region. While several proven tools exist for accurate GC diagnosis, a universal modality for the screening of GC populations remains elusive. Full article
(This article belongs to the Special Issue Oesogastric Cancer: Treatment and Management)
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