Department of Surgical Gastroenterology, Rigshospitalet, University of Copenhagen, Denmark 2
|
|
- Matilda Nash
- 6 years ago
- Views:
Transcription
1 598760SJS / The MDT s decision on M-staging in patients with gastric- and gastroesophageal cancer is not accurate without staging laparoscopyr. B. Strandby, L. B. Svendsen, E. Fallentin, C. Egeland, M. P. Achiam research-article2015 Original Article The Multidisciplinary Team Conference s Decision on M-Staging in Patients with Gastric- and Gastroesophageal Cancer is not Accurate without Staging Laparoscopy R. B. Strandby 1, L. B. Svendsen 1, E. Fallentin 2, C. Egeland 1, M. P. Achiam 1 1 Department of Surgical Gastroenterology, Rigshospitalet, University of Copenhagen, Denmark 2 Department of Radiology, Rigshospitalet, University of Copenhagen, Denmark Abstract Background: The implementation of the multidisciplinary team conference has been shown to improve treatment outcome for patients with gastric- and gastroesophageal cancer. Likewise, the staging laparoscopy has increased the detection of patients with disseminated disease, that is, patients who do not benefit from a surgical resection. The aim of this study was to compare the multidisciplinary team conference s decision in respect of M-staging with the findings of the following staging laparoscopy. Methods: Patients considered operable and resectable within the multidisciplinary team conference in the period were retrospectively reviewed. Patient data were retrieved by searching for specific diagnosis and operation codes in the in-house system. The inclusion criteria were as follows: biopsy-verified cancer of the esophagus, gastroesophageal junction or stomach, and no suspicion of peritoneal carcinomatosis or liver metastases on multidisciplinary team conference before staging laparoscopy. Furthermore, an evaluation with staging laparoscopy was required. Results: In total, 222 patients met the inclusion criteria. Most cancers were located in the gastroesophageal junction, n = 171 (77.0%), and most common with adenocarcinoma histology, n = 196 (88.3%). The staging laparoscopy was M1-positive for peritoneal carcinomatosis in eight patients (16.7%) with gastric cancer versus nine patients (5.3%) with gastroesophageal junction cancer. Furthermore, liver metastases were evident in zero patients (0.0%) and four patients (2.3%) with gastric- and gastroesophageal junction cancer, respectively. The staging laparoscopy findings regarding peritoneal carcinomatosis were significantly different between gastric- and gastroesophageal junction cancers, p = No significant differences were found regarding T-/N-stage or histological tumor characteristics between the positive- and negative-staging laparoscopy group. Correspondence: Rune B. Strandby Department of Surgical Gastroenterology Rigshospitalet University of Copenhagen Denmark rune.broni.strandby.01@regionh.dk Scandinavian Journal of Surgery 2016, Vol. 105(2) The Finnish Surgical Society 2015 Reprints and permissions: sagepub.co.uk/journalspermissions.nav DOI: / sjs.sagepub.com
2 The MDT s decision on M-staging in patients with gastric- and gastroesophageal cancer is not accurate without staging laparoscopy 105 Conclusion: The M-staging of the multidisciplinary team conference without staging laparoscopy lacks accuracy concerning peritoneal carcinomatosis. Staging laparoscopy remains an essential part of the preoperative detection of disseminated disease in patients with gastric- and gastroesophageal cancer. Key words: Staging laparoscopy; gastric cancer; gastroesophageal cancer; multidisciplinary team conference Introduction Patients with gastric- and gastroesophageal cancer have a poor prognosis, mainly due to advanced tumor stage and disseminated disease at presentation. Consequently, only 35% 40% of patients are undergoing intended curative therapy (1, 2). The modern diagnostic work-up in the management of gastric- and gastroesophageal cancer includes the multidisciplinary team conference (MDT). The purpose of the MDT is to discuss the patients individually from different medical viewpoints, with the aim of choosing the most optimal treatment and optimize outcome. Several studies have shown that MDT increases the percentage of patients receiving complete staging, and decreases the time from diagnosis to treatment and, hence, is of benefit for the patients (3, 4). In the preoperative assessment, the introduction of the staging laparoscopy (SL) has also contributed significantly to the identification of peritoneal carcinomatosis (PC) and liver metastases (LM), not verified by computed tomography (CT) (5, 6). Thus, futile laparotomies may be avoided and appropriate palliative treatment initiated for patients with disseminated disease. At our department, we introduced SL in Still, not all Danish institutions perform SL but maintain an MDT as the exclusive basis of treatment decision. Therefore, we aimed to determine how precise our MDT was in respect of M-staging in comparison with the findings of the following SL. Methods Patients considered operable and resectable with a biopsy-verified cancer of the stomach, gastroesophageal junction (GEJ), or esophagus were identified between 2010 and 2012 by searching for specific diagnosis and operation codes in the in-house system. The retrieved data were assessed by two independent reviewers (Strandby R.B. and Egeland C.), and eventual discrepancies were ruled out by reassessing the medical journals. For inclusion, no suspicion of PC or LM at MDT was required. Likewise, accessible information of the SL performed was mandatory. The study was approved by The Danish Data Protection Agency and the Danish Health and Medical Authorities. Multidisciplinary Team Conference All patients were discussed at the MDT. The tumor board consisted of highly specialized consultants from the specialties: surgical gastroenterology, thoracic surgery, radiology, oncology, pathology, and nuclear medicine. Before evaluation at MDT, the patients underwent a diagnostic work-up including physical examination, spirometry, upper endoscopy with biopsy, CT of the chest and abdomen combined with ultrasound of the neck, and/or positron emission tomographycomputed tomography (PET-CT) for tumor staging. The CT-scanners used were multidetector-ct scanners (MDCT) with detectors. On the basis of the patients estimated TNM-stage (TNM Seventh edition (7)), comorbidity, and resectability, a consensus on treatment strategy was reached between the physicians at the tumor board. If the patients did not have any signs of disseminated disease on CT, PET-CT, or ultrasound of the neck, and had no or an acceptable degree of comorbidity, a SL was scheduled. SL was performed to rule out PC, LM, or other sites of potential dissemination before further treatment was established. Staging Laparoscopy After induction of general anesthesia, a 5 mm supraumbilical- or subumbilical-incision was made. Abdominal access was established preferably with Verres Cannula or open technique ad modum Hassan, depending on the individual patient s surgical anamnesis. After adequate insufflation of CO 2 in the peritoneal cavity, a 5 mm trocar was placed below or above the umbilicus. The four quadrants were inspected thoroughly for any malignancy, that is, PC or LM. If indicated, a second trocar was placed to elevate the left liver lobe or mobilize the omentum for optimized visibility of the stomach or GEJ. Intraoperative ultrasound was not performed; thus, only superficial lesions could be assessed. Moreover, PC was defined as any suspicious lesions on the peritoneal surface including the greater omentum. If suspicious plaques and/or acites were evident, biopsies were obtained and/or ascites were aspirated for analysis. For patients with negative findings on SL, neoadjuvant chemotherapy and subsequent resection of tumor were offered. Statistics Statistics was made with IBM SPSS version (SPSS, Inc, Chicago, IL). The distribution of independent variables was characterized with descriptive statistics. Pearson s chi-square and Fisher s exact test was used for nominal variables. A two-sided p-value 0.05 was considered significant.
3 106 R. B. Strandby, et al. Table 1 Patient characteristics. n (%) Patients 222 Sex M 169 (76.1) F 53 (23.9) Age <50 9 (4.1) (55.9) >70 89 (40.1) Cancer site Stomach total 48 (21.6) Antrum 21 (43.8) Corpus 20 (41.7) Diffuse 7 (14.6) GEJ total 171 (77.0) Siewert 1 66 (38.6) Siewert 2 71 (41.5) Siewert 3 15 (8.8) Distal esophagus 19 (11.1) Esophagus total 3 (1.4) T-stage (MDT 1 ) TX 2 (0.9) T1 2 (0.9) T2 29 (13.1) T3 159 (71.6) T4 30 (13.5) N-stage (MDT 1 ) NX 7 (3.2) N0 62 (27.9) N1 100 (45.0) N2 49 (22.1) N3 4 (1.8) Cancer histology Adenocarcinoma 196 (88.3) Signet ring 19 (8.6) Squamous 3 (1.4) Mixed 2 (0.9) Neuroendocrine 2 (0.9) 1: estimated TN-stage at MDT. Values are given as number of observations with percentages (%). Results In a 24-month period, 230 patients of all patients discussed on the MDT received a SL. Of those, there was no suspicion of PC or LM in 222 patients before SL was performed. These patients accounted for the study cohort. Eight patients were excluded due to initial suspicion of LM (n = 2) and PC (n = 6) at MDT, which were biopsy-verified by SL. These patients were all offered palliative chemotherapy without primary resection of tumor. Only 22 (9.6%) patients received a PET-CT. Of those, there was suspicion of LM in one patient, and PC in one patient, which was biopsy-verified at the following SL. Thus, 20 patients had a negative PET-CT and SL. The primary cancer was located in the GEJ in 171 patients (77.0%), the stomach in 48 patients (21.6%), and the esophagus in 3 patients (1.4%). These cancers were most commonly adenocarcinomas (88.3%) with an advanced T- and N-stage (Table 1). All 222 patients underwent a SL after the MDT. The overall findings of the examination were negative in 90.5%, and 9.5% were positive for either LM or PC. All metastases were histologically verified. Of patients (n = 48) with gastric cancer, the SL identified 16.7% and 0.0% with PC and LM, respectively. In comparison, the SL identified only 5.3% with PC and 2.3% with LM in GEJ cancers (n = 171) (Table 2). None of the three patients with esophageal cancer had disseminated disease. The differences between the SL findings regarding PC between stomach- and GEJ cancers were significant, p = Due to small numbers, nothing could be concluded for esophageal cancers. A subanalysis was made to compare staging and histogical characteristics between the positive SL (+SL) and the negative SL group ( SL) (Table 3). More tumors in the SL+ groups were signet ring cell carcinomas (19.0% vs 7.6%), with more advanced N-stages (81.0% vs 67.2%) and T-stages (90.5% vs 84.8%). However, no significant differences were found between the groups regarding T-stage (p = 0.8), N-stage (p = 0.3), or cancer histology (p = 0.2). Discussion This study found a significant benefit of SL, yielding M1-positive disease in overall 9.5% of patients with gastric- and gastroesophageal cancer, who were initially considered operable and resectable at MDT. Furthermore, a significantly higher proportion of patients with gastric cancer had PC on SL compared to GEJ cancer. The values of SL in the management of gastric- and gastroesophageal cancer have been reported in several studies, with positive findings in 23% 37.5% for gastric cancer (8 11), and 17% 20% for GEJ cancer (12, 13). Thus, the implementation of SL leads to an altered treatment strategy, or prevents an unnecessary resection of primary tumor of a noteworthy part of the patients examined, due to disseminated disease, and hence poor prognosis. Similarly, PC was found in 16.7% and 5.3% of patients with gastric- and GEJ cancer, in this study. Thus, our results suggest that peritoneal dissemination is less likely present on SL in patients with cancer of the GEJ compared to gastric cancer, and even lower than reported in the literature for both types of cancers. A possible reason for our findings may be that the implementation of the MDT actually optimizes the selection process of resectable patients. Thus, more unresectable or inoperable patients are recognized and correctly palliated, instead of undergoing intended curative therapy. This is in line with findings from a British study, examining the role of MDT with respect to outcome in patients with esophageal cancer (14). The study compared two groups of patients in different time periods, with or without MDT management, respectively. The study found a significant reduction of open and close laparotomies and thoracotomies when patients were assessed on preoperative MDT. Furthermore, MDT strategy was significantly associated with better outcome in the multivariate analysis, HR = 0.34, p < Similar results have been reported for rectal cancer (15) and breast cancer (16).
4 The MDT s decision on M-staging in patients with gastric- and gastroesophageal cancer is not accurate without staging laparoscopy 107 Table 2 Overview of SL findings and univariate analysis for GEJ- and gastric-cancers. Cancer site Patients Negative SL PC 1 p-value LM 2 p-value Stomach (83.3) 8 (16.7) (0.0) n.s. GEJ (92.4) 9 (5.3) 4 (2.3) Overall (90.4) 17 (7.8) 4 (1.8) Values are given as number of observations with percentages (%).The statistical differences, regarding PC and LM, compare stomach cancers to GEJ cancers. Esophageal cancer is not shown due to a small sample size, n = 3. 1: PC: peritoneal carcinomatosis. 2: LM: Liver metastases. Table 3 Sub analysis of staging and histological characteristics of positive and negative SL patients with gastric- or GEJ cancers. Positive SL (n = 21) Negative SL (n = 198) p-value T-stage (MDT 1 ) TX 0 (0.0) 2 (1.0) 0.8 T1/T2 2 (9.5) 28 (14.1) T3/T4 19 (90.5) 168 (84.8) N-stage (MDT 1 ) NX 1 (4.8) 6 (3.0) 0.3 N0 3 (14.3) 59 (29.8) N 1 17 (81.0) 133 (67.2) Cancer histology Adenocarcinoma 17 (81.0) 177 (89.4) 0.2 Signet ring 4 (19.0) 15 (7.6) Other 0 (0.0) 6 (3.0) 1: estimated TN-stage at MDT. Values are given as number of observations with percentages (%). Though the MDT seems to benefit the patients, there is still a considerable lack of staging sensitivity, especially when determining M1-disease with PC. This was demonstrated by our findings of 16.7% PC-positive patients at SL for gastric cancer with no initial suspicion of M1-disease. The CT-scan is the cornerstone of the MDT and of substantial value; however, several limitations exist. Despite the fact that a reasonable evaluation of the omentum and larger peritoneal nodules can be achieved, there is still a considerable lack of sensitivity in the evaluation of peritoneal nodules <5 mm (17). The ability to identify PC depends on the slice thickness of the CT-scan, and the introduction of MDCT with thin slices and multiplanar reformation has improved detection of peritoneal nodules (18). This may explain the diverging rates of sensitivity for identifying PC from 14% 76% reported in the literature (18, 19). In contrast, our findings of only 2.3% and 0.0% of LM for GEJ and gastric cancer on SL indicate that the MDT, with decent accuracy, detects these patients before SL is performed. The impact of MDT on CT-scan accuracy has also been examined (20). A study from 2002 compared the TNM-staging of the preoperative CT-scan between one specialized MDT radiologist and several non-mdt radiologists. The study found a significant difference of 25% versus 5% of M-staging-sensitivity between the MDT radiologists and the non-mdt radiologist. Moreover, the MDT radiologist improved the detection of local invasion more than twofold, and the detection of suspicious lymph nodes over threefold, compared to the non- MDT radiologists. Although, the CT-sensitivity for M-staging was low, even for the specialized radiologist, the study emphasizes the importance of a highly specialized preoperative assessment to achieve a better selection of patients suitable for surgery. With the purpose of increasing M-staging accuracy, PET-CT has been introduced and examined in comparison with CT and SL. The PET-CT may provide additional information of occult metastatic disease not verified by conventional imaging like distal- or paraaortic lymph nodes or LM (21). A study from 2012 examined 113 patients with advanced gastric- and gastroesophageal cancer. The aim was to evaluate the role of PET-CT in addition to the standard treatment paradigm (21). Of the patients included, 27% had biopsy-verified metastatic disease prior to surgery. PET-CT confirmed only 10% of the dissemination compared to 19% for SL, and only one patient was positive by both modalities. Thus, a minimal overlap was observed. In addition, no patients with PC were identified with PET-CT and one false-positive result was found. Hence, the authors concluded that PET-CT could not be a substitute for SL but add additional staging information, because of the ability to detect M1-disease not visualized on SL. Furthermore, an
5 108 R. B. Strandby, et al. interesting finding was that if PET-CT was performed prior to SL, one of 10 patients would spare an unnecessary laparoscopy due to clear disseminated disease visualized on PET-CT images. Consequently, the implementation of PET-CT would be of benefit for the patients, reduce the costs of the preoperative assessment, and optimize resources. However, these findings need to be validated in a larger cohort. The additional benefit of PET-CT on decision-making within MDT has also been reported in a recent study evaluating 418 patients (22). The study found that PET-CT prevented 19.7% of patients from undergoing radical treatment due to undetected disseminated disease on CT. The study concluded that PET-CT should be incorporated as a standard modality in the preoperative assessment of gastroesophageal cancer. However, the authors emphasized that PET-positive lesions required bioptic verification for diagnosis of disseminated disease. Thus, the results from these studies underlines an interesting potential for PET-CT, but SL should not be spared in patients with an advanced T- and N-stage, that is, tumors with a high dissemination potential. Our findings of 91% with stage T3/T4 and 81% with a N-stage 1 of patients with a positive SL (Table 3) supports this and international guidelines recommend that SL should be performed in patients with a minimum stage of T1N+ and higher stages of gastric- and GEJ cancers (23). Our study cohort of 222 patients was evaluated by the same MDT, which we consider a major strength in our study. This may reduce selection bias in this retrospective study. Unfortunately, we did not have a historical group without MDT assessment to compare our findings with. This would have strengthened our results. Only 10% of the patients received a PET-CTscan. This modality was not a part of the standard diagnostic work-up in the study period, which is why no data are presented for this modality. In conclusion, our study shows that the MDT conclusion based on diagnostic imaging has a high accuracy for LM, but lacks accuracy for PC. For that reason, SL remains a vital modality in the detection of PC. Declaration Of Conflicting Interests None of the authors have any conflicting interests to disclose. Ethics Approval This study was approved by the The Danish Data Protection Agency (ID: ) and the Danish Health and Medical Authorities (ID: /1/). Funding This study was partially sponsored by The Danish Cancer Organization (grant number R84-A5558). References 1. Lello E, Furnes B, Edna TH: Short and long-term survival from gastric cancer. A population-based study from a county hospital during 25 years. Acta Oncol 2007;46: The Danish Esophagus-, Cardiac-, and Gastric Cancer Group (DECV). Year report 2013, Files/Dokumenter/Dansk%20esophagus%20cardia%20og%20 ventrikelkarcinom%20database%20%c3%a5rsrapport% pdf (accessed 2 December 2014). 3. Freeman RK, Van Woerkom JM, Vyverberg A et al: The effect of a multidisciplinary thoracic malignancy conference on the treatment of patients with esophageal cancer. Ann Thorac Surg 2011;92: ;discussion Davies AR, Deans DA, Penman I et al: The multidisciplinary team meeting improves staging accuracy and treatment selection for gastro-esophageal cancer. Dis Esophagus 2006;19: Gretschel S, Siegel R, Estevez-Schwarz L et al: Surgical strategies for gastric cancer with synchronous peritoneal carcinomatosis. Br J Surg 2006;93: Burbidge S, Mahady K, Naik K: The role of CT and staging laparoscopy in the staging of gastric cancer. Clin Radiol 2013;68: Washington K. 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol 2010;17: Burke EC, Karpeh MS, Conlon KC et al: Laparoscopy in the management of gastric adenocarcinoma. Ann Surg 1997;225: Sarela AI, Lefkowitz R, Brennan MF et al: Selection of patients with gastric adenocarcinoma for laparoscopic staging. Am J Surg 2006;191: Muntean V, Mihailov A, Iancu C et al: Staging laparoscopy in gastric cancer. Accuracy and impact on therapy. J Gastrointestin Liver Dis 2009;18: Lowy AM, Mansfield PF, Leach SD et al: Laparoscopic staging for gastric cancer. Surgery 1996;119: de Graaf GW, Ayantunde AA, Parsons SL et al: The role of staging laparoscopy in oesophagogastric cancers. Eur J Surg Oncol 2007;33: Romijn MG, van Overhagen H, Spillenaar Bilgen EJ: Laparoscopy and laparoscopic ultrasonography in staging of oesophageal and cardial carcinoma. Br J Surg 1998;85: Stephens MR, Lewis WG, Brewster AE et al: Multidisciplinary team management is associated with improved outcomes after surgery for esophageal cancer. Dis Esophagus 2006;19: Burton S, Brown G, Daniels IR et al: MRI directed multidisciplinary team preoperative treatment strategy: the way to eliminate positive circumferential margins? Br J Cancer 2006;94: Kesson EM, Allardice GM, George WD et al: Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of women. BMJ 2012;344:e Alfredo Garofalo M, Mario Valle MD: Laparoscopy in the management of peritoneal carcinomatosis. Cancer J 2009;15: Lim JS, Kim MJ, Yun MJ et al: Comparison of CT and 18F-FDG pet for detecting peritoneal metastasis on the preoperative evaluation for gastric carcinoma. Korean J Radiol 2006;7: Bonavina L, Incarbone R, Lattuada E et al: Preoperative laparoscopy in management of patients with carcinoma of the esophagus and of the esophagogastric junction. J Surg Oncol 1997;65: Barry JD, Edwards P, Lewis WG et al: Special interest radiology improves the perceived preoperative stage of gastric cancer. Clin Radiol 2002;57: Smyth E, Schoder H, Strong VE et al: A prospective evaluation of the utility of 2-deoxy-2-[(18) F]fluoro-D-glucose positron emission tomography and computed tomography in staging locally advanced gastric cancer. Cancer 2012;118: Blencowe NS, Whistance RN, Strong S et al: Evaluating the role of fluorodeoxyglucose positron emission tomography-computed tomography in multi-disciplinary team recommendations for oesophago-gastric cancer. Br J Cancer 2013;109: Waddell T, Verheij M, Allum W et al: Gastric cancer: ESMO- ESSO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013;24(Suppl. 6):vi57 vi63. Received: February 8, 2015 Accepted: June 29, 2015
Imaging in gastric cancer
Imaging in gastric cancer Gastric cancer remains a deadly disease because of late diagnosis. Adenocarcinoma represents 90% of malignant tumors. Diagnosis is based on endoscopic examination with biopsies.
More informationDysphagia Is Not A Valuable Indicator Of Tumor Response
594716SJS0010.1177/1457496915594716Dysphagia is not a valuable indicator of tumor response after preoperative chemotherapy for R0 resected patients with cancer of the GEJR. B. Strandby, et al. research-article2015
More informationIndex. Surg Oncol Clin N Am 16 (2007) Note: Page numbers of article titles are in boldface type.
Surg Oncol Clin N Am 16 (2007) 465 469 Index Note: Page numbers of article titles are in boldface type. A Adjuvant therapy, preoperative for gastric cancer, staging and, 339 B Breast cancer, metabolic
More informationAppendix 1: Regional Lymph Node Stations for Staging Esophageal Cancer
Appendix 1: Regional Lymph Node Stations for Staging Esophageal Cancer Locoregional (N stage) disease was redefined in the seventh edition of the AJCC Cancer Staging Manual as any periesophageal lymph
More informationEsophageal cancer: Biology, natural history, staging and therapeutic options
EGEUS 2nd Meeting Esophageal cancer: Biology, natural history, staging and therapeutic options Michael Bau Mortensen MD, Ph.D. Associate Professor of Surgery Centre for Surgical Ultrasound, Upper GI Section,
More informationUpper GI Malignancies Imaging Guidelines for the Management of Gastric, Oesophageal & Pancreatic Cancers 2012
Upper GI Malignancies Imaging Guidelines for the Management of Gastric, Oesophageal & Pancreatic Cancers 2012 Version Control This is a controlled document please destroy all previous versions on receipt
More informationProspective Clinical Trial of Diagnostic Peritoneal Lavage to Detect Positive Peritoneal Cytology in Patients With Gastric Cancer
2013;107:794 798 Prospective Clinical Trial of Diagnostic Peritoneal Lavage to Detect Positive Peritoneal Cytology in Patients With Gastric Cancer JAMES J. MEZHIR, MD, MITCHELL C. POSNER, MD, AND KEVIN
More informationA Proposed Strategy for Treatment of Superficial Carcinoma. in the Thoracic Esophagus Based on an Analysis. of Lymph Node Metastasis
Kitakanto Med J 2002 ; 52 : 189-193 189 A Proposed Strategy for Treatment of Superficial Carcinoma in the Thoracic Esophagus Based on an Analysis of Lymph Node Metastasis Susumu Kawate,' Susumu Ohwada,'
More informationCase Scenario year-old white male presented to personal physician with dyspepsia with reflux.
Case Scenario 1 57-year-old white male presented to personal physician with dyspepsia with reflux. 7/12 EGD: In the gastroesophageal junction we found an exophytic tumor. The tumor occupies approximately
More informationMetastatic mechanism of spermatic cord tumor from stomach cancer
Int Canc Conf J (2013) 2:191 195 DOI 10.1007/s13691-013-0-9 CANCER BOARD CONFERENCE Metastatic mechanism of spermatic cord tumor from stomach cancer Masahiro Seike Yoshikazu Kanazawa Ryuji Ohashi Tadashi
More informationRecommendations for cross-sectional imaging in cancer management, Second edition
www.rcr.ac.uk Recommendations for cross-sectional imaging in cancer management, Second edition Carcinoma of unknown primary origin (CUP) Faculty of Clinical Radiology www.rcr.ac.uk Contents Carcinoma of
More informationStaging Laparoscopy in the Management of Gastric Cancer: A Population-Based Analysis
Staging Laparoscopy in the Management of Gastric Cancer: A Population-Based Analysis Paul J Karanicolas, MD, PhD, Elena B Elkin, PhD, Lindsay M Jacks, MSc, Coral L Atoria, MPH, Vivian E Strong, MD, FACS,
More informationEvidence tabel stadiering
Evidence tabel stadiering Auteurs, T stage Syst Reviews Kwee, 2007 Systematic review Studies included up to aug 2006 Kelly, 2001 Systematic review Studies included from 1991-1996 steekproefgrootte) Included
More informationDepth of tumor invasion and tumor-occupied portions of stomach are predictive factors of intra-abdominal metastasis
Original Article on Gastric Cancer Depth of tumor invasion and tumor-occupied portions of stomach are predictive factors of intra-abdominal metastasis Ziyu Li 1*, Zhemin Li 1*, Shuqin Jia 2*, Zhaode Bu
More informationIntraoperative staging of GIT cancer using Intraoperative Ultrasound
Intraoperative staging of GIT cancer using Intraoperative Ultrasound Thesis For Fulfillment of MSc Degree In Surgical Oncology By Abdelhalim Salah Abdelhalim Moursi M.B.B.Ch (Cairo University ) Supervisors
More informationEpidemiology, aetiology and the patient pathway in oesophageal and pancreatic cancers
Epidemiology, aetiology and the patient pathway in oesophageal and pancreatic cancers Dr Ian Chau Consultant Medical Oncologist Women's cancers Breast cancer introduction 3 What profession are you in?
More informationAdenocarcinoma of gastro-esophageal junction - Case report
Case Report denocarcinoma of gastro-esophageal junction - Case report nupsingh Dhakre 1*, Ibethoi Yengkhom 2, Harshin Nagori 1, nup Kurele 1, Shreedevi. Patel 3 1 2 nd year Resident, 2 3rd year Resident,
More informationThe Effect of a Multidisciplinary Thoracic Malignancy Conference on the Treatment of Patients With Esophageal Cancer
The Effect of a Multidisciplinary Thoracic Malignancy Conference on the Treatment of Patients With Esophageal Cancer Richard K. Freeman, MD, Jaclyn M. Van Woerkom, RN, BSN, Amy Vyverberg, RN, BSN, and
More informationClinical Study Staging Laparoscopy in Carcinoma of Stomach: A Comparison with CECT Staging
Hindawi Publishing Corporation International Journal of Surgical Oncology Volume 2013, Article ID 674965, 5 pages http://dx.doi.org/10.1155/2013/674965 Clinical Study Staging Laparoscopy in Carcinoma of
More informationCT PET SCANNING for GIT Malignancies A clinician s perspective
CT PET SCANNING for GIT Malignancies A clinician s perspective Damon Bizos Head, Surgical Gastroenterology Charlotte Maxeke Johannesburg Academic Hospital Case presentation 54 year old with recent onset
More informationRestaging after neoadjuvant chemoradiation in rectal cancers: is histology the key in patient selection?
Original Article Restaging after neoadjuvant chemoradiation in rectal cancers: is histology the key in patient selection? Nitin Singhal 1, Karthik Vallam 1, Reena Engineer 2, Vikas Ostwal 3, Supreeta Arya
More informationSummary of the study protocol of the FLOT3-Study
Summary of the study protocol of the FLOT3-Study EudraCT no. 2007-005143-17 Protocol Code: S396 Title A Prospective Multicenter Study With 5-FU, Leucovorin, Oxaliplatin and Docetaxel (FLOT) in Patients
More informationNational Oesophago-Gastric Cancer Audit New Patient Registration sheet Patients with Oesophageal High Grade Glandular Dysplasia
National Oesophago-Gastric Cancer Audit New Patient Registration sheet Patients with Oesophageal High Grade Glandular Dysplasia Patient Details Surname: NHS number: Forename: Postcode: Sex: Male Female
More informationHEPATIC METASTASES. We can state 3 types of metastases depending on their treatment options:
HEPATIC METASTASES 1. Definition Metastasis means the spread of cancer. Cancerous cells can separate from the primary tumor and enter the bloodstream or the lymphatic system (the one that produces, stores,
More informationCancer of Unknown Primary (CUP)
Cancer of Unknown Primary (CUP) Pathways and Guidelines V1.0 London Cancer September 2013 The following pathways and guidelines document has been compiled by the London Cancer CUP technical subgroup and
More informationTitle: What is the role of pre-operative PET/PET-CT in the management of patients with
Title: What is the role of pre-operative PET/PET-CT in the management of patients with potentially resectable colorectal cancer liver metastasis? Pablo E. Serrano, Julian F. Daza, Natalie M. Solis June
More informationMinimally Invasive Esophagectomy- Valuable. Jayer Chung, MD University of Colorado Health Sciences Center December 11, 2006
Minimally Invasive Esophagectomy- Valuable Jayer Chung, MD University of Colorado Health Sciences Center December 11, 2006 Overview Esophageal carcinoma What is minimally invasive esophagectomy (MIE)?
More informationis time consuming and expensive. An intra-operative assessment is not going to be helpful if there is no more tissue that can be taken to improve the
My name is Barry Feig. I am a Professor of Surgical Oncology at The University of Texas MD Anderson Cancer Center in Houston, Texas. I am going to talk to you today about the role for surgery in the treatment
More informationColorectal Cancer and FDG PET/CT
Hybrid imaging in colorectal & esophageal cancer Emmanuel Deshayes IAEA WorkShop, November 2017 Colorectal Cancer and FDG PET/CT 1 Clinical background Cancer of the colon and rectum is one of the most
More informationPre-operative assessment of patients for cytoreduction and HIPEC
Pre-operative assessment of patients for cytoreduction and HIPEC Washington Hospital Center Washington, DC, USA Ovarian Cancer Surgery New Strategies Bergamo, Italy May 5, 2011 Background Cytoreductive
More informationUtility of PET-CT for detection of N2 or N3 nodal mestastases in the mediastinum in patients with non-small cell lung cancer (NSCLC)
Utility of PET-CT for detection of N2 or N3 nodal mestastases in the mediastinum in patients with non-small cell lung cancer (NSCLC) Poster No.: C-1360 Congress: ECR 2015 Type: Scientific Exhibit Authors:
More informationLos Angeles Radiological Society 62 nd Annual Midwinter Radiology Conference January 31, 2010
Los Angeles Radiological Society 62 nd Annual Midwinter Radiology Conference January 31, 2010 Self Assessment Module on Nuclear Medicine and PET/CT Case Review FDG PET/CT IN LYMPHOMA AND MELANOMA Submitted
More informationMUSCLE-INVASIVE AND METASTATIC BLADDER CANCER
MUSCLE-INVASIVE AND METASTATIC BLADDER CANCER (Text update March 2008) A. Stenzl (chairman), N.C. Cowan, M. De Santis, G. Jakse, M. Kuczyk, A.S. Merseburger, M.J. Ribal, A. Sherif, J.A. Witjes Introduction
More informationEsophageal Cancer. What is esophageal cancer?
Scan for mobile link. Esophageal Cancer Esophageal cancer occurs when cancer cells develop in the esophagus. The two main types are squamous cell carcinoma and adenocarcinoma. Esophageal cancer may not
More informationMediastinal Staging. Samer Kanaan, M.D.
Mediastinal Staging Samer Kanaan, M.D. Overview Importance of accurate nodal staging Accuracy of radiographic staging Mediastinoscopy EUS EBUS Staging TNM Definitions T Stage Size of the Primary Tumor
More informationPerioperative management of esophageal cancer
Perioperative management of esophageal cancer Lucas Goense Perioperative management of esophageal cancer Lucas Goense Perioperative management of esophageal cancer PhD thesis, Utrecht University, The
More informationDEPARTMENT OF ONCOLOGY ELECTIVE
DEPARTMENT OF ONCOLOGY ELECTIVE 2015-2016 www.uwo.ca/oncology Oncology Elective Program Administrator: Ms. Kimberly Trudgeon Room A4-901C (Admin) LHSC London Regional Cancer Centre (Victoria Campus) Phone:
More informationCase Scenario 1. The patient has now completed his neoadjuvant chemoradiation and has been cleared for surgery.
Case Scenario 1 July 10, 2010 A 67-year-old male with squamous cell carcinoma of the mid thoracic esophagus presents for surgical resection. The patient has completed preoperative chemoradiation. This
More informationDr Sneha Shah Tata Memorial Hospital, Mumbai.
Dr Sneha Shah Tata Memorial Hospital, Mumbai. Topics covered Lymphomas including Burkitts Pediatric solid tumors (non CNS) Musculoskeletal Ewings & osteosarcoma. Neuroblastomas Nasopharyngeal carcinomas
More informationNorth of Scotland Cancer Network Clinical Management Guideline for Non Small Cell Lung Cancer
THIS DOCUMENT IS North of Scotland Cancer Network Clinical Management Guideline for Non Small Cell Lung Cancer [Based on WOSCAN NSCLC CMG with further extensive consultation within NOSCAN] UNCONTROLLED
More information5/8/2014. AJCC Stage Introduction and General Rules. Acknowledgements* Introduction. Melissa Pearson, CTR North Carolina Central Cancer Registry
AJCC Stage Introduction and General Rules Linda Mulvihill Public Health Advisor NCRA Annual Meeting May 2014 National Center for Chronic Disease Prevention and Health Promotion Division of Cancer Prevention
More informationLYMPHATIC DRAINAGE IN THE HEAD & NECK
LYMPHATIC DRAINAGE IN THE HEAD & NECK Like other parts of the body, the head and neck contains lymph nodes (commonly called glands). Which form part of the overall Lymphatic Drainage system of the body.
More informationperformed to help sway the clinician in what the appropriate diagnosis is, which can substantially alter the treatment of management.
Hello, I am Maura Polansky at the University of Texas MD Anderson Cancer Center. I am a Physician Assistant in the Department of Gastrointestinal Medical Oncology and the Program Director for Physician
More informationFDG PET/CT STAGING OF LUNG CANCER. Dr Shakher Ramdave
FDG PET/CT STAGING OF LUNG CANCER Dr Shakher Ramdave FDG PET/CT STAGING OF LUNG CANCER FDG PET/CT is used in all patients with lung cancer who are considered for curative treatment to exclude occult disease.
More informationACOS Inquiry and Response Selected Inquires CS Tumor Size/Extension Evaluation, CS Lymph Nodes Evaluation, CS Metastasis at Diagnosis Evaluation *
ACOS Inquiry and Response Selected Inquires CS Tumor Size/Extension Evaluation, CS Lymph Nodes Evaluation, CS Metastasis at Diagnosis Evaluation * CS Tumor Size/Extension Evaluation 24842 12/11/2007: Q:
More informationIntended for use by Clinicians and Health Care Providers involved in the Management or Referral of adult patients with pancreatic
Intended for use by Clinicians and Health Care Providers involved in the Management or Referral of adult patients with pancreatic cancer Section AA Cancer Centre Referrals In the absence of metastatic
More informationThe Royal Marsden. Surgery for Gastric and GE Junction Cancer: primary palliative when and where? William Allum Consultant Surgeon
The Royal Marsden Surgery for Gastric and GE Junction Cancer: primary palliative when and where? William Allum Consultant Surgeon Any surgeon can cure Surgeon - dependent No surgeon can cure EMR D2 GASTRECTOMY
More informationDetermining the Optimal Surgical Approach to Esophageal Cancer
Determining the Optimal Surgical Approach to Esophageal Cancer Amit Bhargava, MD Attending Thoracic Surgeon Department of Cardiovascular and Thoracic Surgery Open Esophagectomy versus Minimally Invasive
More informationAccuracy of endoscopic ultrasound staging for T2N0 esophageal cancer: a national cancer database analysis
Review Article Accuracy of endoscopic ultrasound staging for T2N0 esophageal cancer: a national cancer database analysis Ravi Shridhar 1, Jamie Huston 2, Kenneth L. Meredith 2 1 Department of Radiation
More informationComparison of RECIST version 1.0 and 1.1 in assessment of tumor response by computed tomography in advanced gastric cancer
Original Article Comparison of RECIST version 1.0 and 1.1 in assessment of tumor response by computed tomography in advanced gastric cancer Gil-Su Jang 1 *, Min-Jeong Kim 2 *, Hong-Il Ha 2, Jung Han Kim
More informationThe Itracacies of Staging Patients with Suspected Lung Cancer
The Itracacies of Staging Patients with Suspected Lung Cancer Gerard A. Silvestri, MD,MS, FCCP Professor of Medicine Medical University of South Carolina Charleston, SC silvestri@musc.edu Staging Lung
More informationCase Report Solitary Osteolytic Skull Metastasis in a Case of Unknown Primary Being latter Diagnosed as Carcinoma of Gall Bladder
Cronicon OPEN ACCESS CANCER Case Report Solitary Osteolytic Skull Metastasis in a Case of Unknown Primary Being latter Diagnosed as Carcinoma of Gall Kartik Mittal 1, Rajaram Sharma 1, Amit Dey 1, Meet
More informationPOSITRON EMISSION TOMOGRAPHY (PET)
Status Active Medical and Behavioral Health Policy Section: Radiology Policy Number: V-27 Effective Date: 08/27/2014 Blue Cross and Blue Shield of Minnesota medical policies do not imply that members should
More informationA variation in recurrence patterns of papillary thyroid cancer with disease progression: A long-term follow-up study
ORIGINAL ARTICLE A variation in recurrence patterns of papillary thyroid cancer with disease progression: A long-term follow-up study Joon-Hyop Lee, MD, Yoo Seung Chung, MD, PhD,* Young Don Lee, MD, PhD
More informationCOLORECTAL CARCINOMA
QUICK REFERENCE FOR HEALTHCARE PROVIDERS MANAGEMENT OF COLORECTAL CARCINOMA Ministry of Health Malaysia Malaysian Society of Colorectal Surgeons Malaysian Society of Gastroenterology & Hepatology Malaysian
More informationEsophageal seeding after endoscopic ultrasound-guided fine-needle aspiration of a mediastinal tumor
Esophageal seeding after endoscopic ultrasound-guided fine-needle aspiration of a mediastinal tumor Authors Kensuke Yokoyama 1,JunUshio 1,NorikatsuNumao 1, Kiichi Tamada 1, Noriyoshi Fukushima 2, Alan
More informationControversies in management of squamous esophageal cancer
2015.06.12 12.47.48 Page 4(1) IS-1 Controversies in management of squamous esophageal cancer C S Pramesh Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, India In Asia, squamous
More informationNeoplasms of the Esophagus and Stomach
Neoplasms of the Esophagus and Stomach Farrokh Dehdashti and Barry A. Siegel Esophageal cancer is one of the most lethal of all neoplasms. During the last two decades, there have been significant changes
More informationEsophageal Cancer Initially Thought to be Accompanied by a Solitary Metastasis to an Intrathoracic Paraaortic Lymph Node
2012 66 5 417 421 Esophageal Cancer Initially Thought to be Accompanied by a Solitary Metastasis to an Intrathoracic Paraaortic Lymph Node a b* a a a a a a a b ʼ 418 Horio et al. Acta Med. Okayama Vol.
More informationInternational Journal of Medical Science and Health Research
A Retrospective Study of Clinicopathological Profiles of Proximal Gastrectomy Vs Distal Gastrectomy in Carcinoma Stomach and Its Incidence in our Population Dr Magesh kumar J 1, Dr V Naveen Kumar 2, Dr
More informationStaging Colorectal Cancer
Staging Colorectal Cancer CT is recommended as the initial staging scan for colorectal cancer to assess local extent of the disease and to look for metastases to the liver and/or lung Further imaging for
More informationDetermining Resectability and Appropriate Surgery for Esophageal Cancer
Determining Resectability and Appropriate Surgery for Esophageal Cancer Peter Baik, DO, FACOS Thoracic Surgery Cancer Treatment Centers of America 1 Esophageal and Esophagogastric Junction Cancers Siewert
More informationNoninvasive Differential Diagnosis of Pulmonary Nodules Using the Standardized Uptake Value Index
doi: 10.5761/atcs.oa.14-00241 Original Article Noninvasive Differential Diagnosis of Pulmonary Nodules Using the Standardized Uptake Value Index Satoshi Shiono, MD, 1 Naoki Yanagawa, MD, 2 Masami Abiko,
More informationTowards a more personalized approach in the treatment of esophageal cancer focusing on predictive factors in response to chemoradiation Wang, Da
University of Groningen Towards a more personalized approach in the treatment of esophageal cancer focusing on predictive factors in response to chemoradiation Wang, Da IMPORTANT NOTE: You are advised
More informationThe right middle lobe is the smallest lobe in the lung, and
ORIGINAL ARTICLE The Impact of Superior Mediastinal Lymph Node Metastases on Prognosis in Non-small Cell Lung Cancer Located in the Right Middle Lobe Yukinori Sakao, MD, PhD,* Sakae Okumura, MD,* Mun Mingyon,
More informationRadiological staging of lung cancer. Shukri Loutfi,MD,FRCR Consultant Thoracic Radiologist KAMC-Riyadh
Radiological staging of lung cancer Shukri Loutfi,MD,FRCR Consultant Thoracic Radiologist KAMC-Riyadh Bronchogenic Carcinoma Accounts for 14% of new cancer diagnoses in 2012. Estimated to kill ~150,000
More informationPancreas Quizzes c. Both A and B a. Directly into the blood stream (not using ducts)
Pancreas Quizzes Quiz 1 1. The pancreas produces hormones. Which type of hormone producing organ is the pancreas? a. Endocrine b. Exocrine c. Both A and B d. Neither A or B 2. Endocrine indicates hormones
More informationEsophageal cancer. What is esophageal cancer? Esophageal cancer is a disease in which malignant (cancer) cells form in the tissues of the esophagus.
Esophageal Cancer Esophageal cancer What is esophageal cancer? What are risk factors? Signs and symptoms Tests for esophageal cancer Stages of esophageal cancer Treatment options What is esophageal cancer?
More informationPredictive risk factors for lymph node metastasis in patients with small size non-small cell lung cancer
Original Article Predictive risk factors for lymph node metastasis in patients with small size non-small cell lung cancer Feichao Bao, Ping Yuan, Xiaoshuai Yuan, Xiayi Lv, Zhitian Wang, Jian Hu Department
More informationSETTING Fudan University Shanghai Cancer Center. RESPONSIBLE PARTY Haiquan Chen MD.
OFFICIAL TITLE A Phase Ⅲ Study of Left Side Thoracotomy Approach (SweetProcedure) Versus Right Side Thoracotomy Plus Midline Laparotomy Approach (Ivor-Lewis Procedure) Esophagectomy in Middle or Lower
More informationFDG-PET/CT in Gynaecologic Cancers
Friday, August 31, 2012 Session 6, 9:00-9:30 FDG-PET/CT in Gynaecologic Cancers (Uterine) cervical cancer Endometrial cancer & Uterine sarcomas Ovarian cancer Little mermaid (Edvard Eriksen 1913) honoring
More informationMUSCLE - INVASIVE AND METASTATIC BLADDER CANCER
10 MUSCLE - INVASIVE AND METASTATIC BLADDER CANCER Recommendations from the EAU Working Party on Muscle Invasive and Metastatic Bladder Cancer G. Jakse (chairman), F. Algaba, S. Fossa, A. Stenzl, C. Sternberg
More informationDiagnosis and staging of breast cancer and multidisciplinary team working
1 Diagnosis and staging of breast cancer and multidisciplinary team working Common symptoms and signs Over 90% of breast cancers (BCs) are local or regional when first detected. At least 60% of patients
More informationSurgical management and neoadjuvant chemotherapy for stage III-IV ovarian cancer
Ovarian cancer Surgical management and neoadjuvant chemotherapy for stage III-IV ovarian cancer JM. Classe, R. Rouzier, O.Glehen, P.Meeus, L.Gladieff, JM. Bereder, F Lécuru Suitable candidates for neo-adjuvant
More informationPET CT for Staging Lung Cancer
PET CT for Staging Lung Cancer Rohit Kochhar Consultant Radiologist Disclosures Neither I nor my immediate family members have financial relationships with commercial organizations that may have a direct
More informationAn Introduction to PET Imaging in Oncology
January 2002 An Introduction to PET Imaging in Oncology Janet McLaren, Harvard Medical School Year III Basics of PET Principle of Physiologic Imaging: Allows in vivo visualization of structures by their
More informationHeated intraperitoneal chemotherapy and gastrectomy for gastric cancer in the U.S.: the time is now
Short Communication Heated intraperitoneal chemotherapy and gastrectomy for gastric cancer in the U.S.: the time is now Zachary J. Brown, Jonathan M. Hernandez, R. Taylor Ripley, Jeremy L. Davis Thoracic
More informationThe Imaging Journey of Patients with Malignant Pleural Mesothelioma: Experience of a Tertiary Mesothelioma MDT
The Imaging Journey of Patients with Malignant Pleural Mesothelioma: Experience of a Tertiary Mesothelioma MDT V. Lam, J. Brozik, A. J. Sharkey, A. Bajaj, D. T. Barnes Glenfield Hospital, Leicester, United
More informationThe Learning Curve for Minimally Invasive Esophagectomy
The Learning Curve for Minimally Invasive Esophagectomy AATS Focus on Thoracic Surgery Mastering Surgical Innovation Las Vegas Nevada Oct. 27-28 2017 Scott J Swanson, M.D. Professor of Surgery Harvard
More informationHow to integrate surgery in the treatment of patients with liver-only metastatic disease
How to integrate surgery in the treatment of patients with liver-only metastatic disease Luis Sabater Ortí MD, PhD Associate Professor University of Valencia European Board Surgical Qualification HBP (EBSQ-HPB)
More informationNEOADJUVANT THERAPY IN CARCINOMA STOMACH. Dr Jyotirup Goswami Consultant Radiation Oncologist Narayana Superspeciality Hospital, Howrah
NEOADJUVANT THERAPY IN CARCINOMA STOMACH Dr Jyotirup Goswami Consultant Radiation Oncologist Narayana Superspeciality Hospital, Howrah NEOADJUVANT THERAPY?! Few believers Limited evidence Many surgeons
More informationTHE ROLE OF CONTEMPORARY IMAGING AND HYBRID METHODS IN THE DIAGNOSIS OF CUTANEOUS MALIGNANT MELANOMA(CMM) AND MERKEL CELL CARCINOMA (MCC)
THE ROLE OF CONTEMPORARY IMAGING AND HYBRID METHODS IN THE DIAGNOSIS OF CUTANEOUS MALIGNANT MELANOMA(CMM) AND MERKEL CELL CARCINOMA (MCC) I.Kostadinova, Sofia, Bulgaria CMM some clinical facts The incidence
More informationResearch Article Evaluation of Prognosis of the Patients with Peritoneal Carcinomatosis in Gastric Carcinoma
Cronicon OPEN ACCESS EC GASTROENTEROLOGY AND DIGESTIVE SYSTEM Research Article Evaluation of Prognosis of the Patients with Peritoneal Carcinomatosis in Gastric Carcinoma Laila Shirin 1 *, Md Mizanur Rahman
More informationStaging Accuracy of Computed Tomography and Endoscopic Ultrasound in Preoperative Staging of Esophageal Cancer: Results of an Referral Center
ARC Journal of Hepatology and Gastroenterology Volume 2, Issue 1, 2017, PP 13-18 www.arcjournals.org Staging Accuracy of Computed Tomography and Endoscopic Ultrasound in Preoperative Staging of Esophageal
More informationMANAGEMENT OF INCIDENTALLY DETECTED GALLBLADDER CANCER
MANAGEMENT OF INCIDENTALLY DETECTED GALLBLADDER CANCER Orlando Jorge M. Torres Full Professor and Chairman Department of Gastrointestinal Surgery Hepatopancreatobiliary Unit Federal University of Maranhão
More informationThe Royal Marsden. Surgery for Gastric and GE Junction Cancer: primary palliative when and where? William Allum
The Royal Marsden Surgery for Gastric and GE Junction Cancer: primary palliative when and where? William Allum The Royal Marsden William Allum Conflict of Interest None Any surgeon can cure Surgeon - dependent
More informationAbstracting Upper GI Cancer Incidence and Treatment Data Quiz 1 Multiple Primary and Histologies Case 1 Final Pathology:
Abstracting Upper GI Cancer Incidence and Treatment Data Quiz 1 Multiple Primary and Histologies Case 1 A 74 year old male with a history of GERD presents complaining of dysphagia. An esophagogastroduodenoscopy
More informationThe following slides are provided as presented by the author during the live educa7onal ac7vity and are intended for reference purposes only.
The following slides are provided as presented by the author during the live educa7onal ac7vity and are intended for reference purposes only. If you have any ques7ons, please contact Imedex via email at:
More informationThe following slides are provided as presented by the author during the live educa7onal ac7vity and are intended for reference purposes only.
The following slides are provided as presented by the author during the live educa7onal ac7vity and are intended for reference purposes only. If you have any ques7ons, please contact Imedex via email at:
More informationNICE guideline Published: 24 January 2018 nice.org.uk/guidance/ng83
Oesophago-gastric cancer: assessment and management in adults NICE guideline Published: 24 January 18 nice.org.uk/guidance/ng83 NICE 18. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationOutcome of rectal cancer after radiotherapy with a long or short waiting period before surgery, a descriptive clinical study
Original Article Outcome of rectal cancer after radiotherapy with a long or short waiting period before surgery, a descriptive clinical study Elmer E. van Eeghen 1, Frank den Boer 2, Sandra D. Bakker 1,
More informationAliu Sanni MD SUNY Downstate Medical Center August 16, 2012
Aliu Sanni MD SUNY Downstate Medical Center August 16, 2012 Case Presentation 60yr old AAF with PMH of CAD s/p PCI 1983, CVA, GERD, HTN presented with retrosternal chest pain on 06/12 Associated dysphagia
More informationPAPER. Positron Emission Tomography in the Initial Staging of Esophageal Cancer
PAPER Positron Emission Tomography in the Initial Staging of Esophageal Cancer Sherry M. Wren, MD; Pascal Stijns, MS; Sandy Srinivas, MD Objective: To assess the value of positron emission tomography (PET)
More informationDisclosure. Acknowledgement. What is the Best Workup for Rectal Cancer Staging: US/MRI/PET? Rectal cancer imaging. None
What is the Best Workup for Rectal Cancer Staging: US/MRI/PET? Zhen Jane Wang, MD Assistant Professor in Residence UC SF Department of Radiology Disclosure None Acknowledgement Hueylan Chern, MD, Department
More informationCOLORECTAL CANCER STAGING in 2010
COLORECTAL CANCER STAGING in 2010 Robert A. Halvorsen, MD, FACR MCV Hospitals / VCU Medical Center Richmond, Virginia I do not have any relevant financial relationships with any commercial interests COLON
More informationGTS. The Journal of Thoracic and Cardiovascular Surgery c Volume 137, Number 3 605
Change in maximum standardized uptake value on repeat positron emission tomography after chemoradiotherapy in patients with esophageal cancer identifies complete responders Robert J. Cerfolio, MD, FACS,
More informationThe solitary pulmonary nodule: Assessing the success of predicting malignancy
The solitary pulmonary nodule: Assessing the success of predicting malignancy Poster No.: C-0829 Congress: ECR 2010 Type: Scientific Exhibit Topic: Chest Authors: R. W. K. Lindsay, J. Foster, K. McManus;
More informationPeritoneal Involvement in Stage II Colon Cancer
Anatomic Pathology / PERITONEAL INVOLVEMENT IN STAGE II COLON CANCER Peritoneal Involvement in Stage II Colon Cancer A.M. Lennon, MB, MRCPI, H.E. Mulcahy, MD, MRCPI, J.M.P. Hyland, MCh, FRCS, FRCSI, C.
More informationChapter 2: Initial treatment for endometrial cancer (including histologic variant type)
Chapter 2: Initial treatment for endometrial cancer (including histologic variant type) CQ01 Which surgical techniques for hysterectomy are recommended for patients considered to be stage I preoperatively?
More information