Comparison of Surgical Management of Thoracic Esophageal Carcinoma Between Two Referral Centers in Japan and China

Size: px
Start display at page:

Download "Comparison of Surgical Management of Thoracic Esophageal Carcinoma Between Two Referral Centers in Japan and China"

Transcription

1 Jpn J Clin Oncol 2001;31(5) Comparison of Surgical Management of Thoracic Esophageal Carcinoma Between Two Referral Centers in Japan and China Wentao Fang 1,HoichiKato 2, Wenhu Chen 1,YujiTachimori 2, Hiroyasu Igaki 2 and Hiroshi Sato 2 1 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China and 2 Department of Surgery, National Cancer Center Hospital, Tokyo, Japan Received October 10, 2000; accepted February 5, 2001 Background: Comparison was made between two referral centers, the National Cancer Center Hospital (NCCH) in Japan and Shanghai Chest Hospital (SCH) in China. The aim was to detect the possible differences between surgical management of thoracic esophageal carcinoma in these two countries and to shed some light on how to improve the therapeutic outcomes at similar institutions. Methods: A total of 98 patients (50 from NCCH and 48 from SCH) with squamous cell carcinoma of the thoracic esophagus treated by a single surgeon at either center during January 1997 to July 1999 were retrospectively reviewed. Results: Lugol staining and endoscopic ultrasonography were applied routinely at NCCH only. More early diseases, multiple lesions and synchronous tumors of the digestive tract were detected in the NCCH group than in the SCH group. Significantly more stations of lymph nodes were dissected and higher metastatic rates to certain stations were found after more extensive lymphadenectomy in the NCCH group. Operation time was prolonged with significantly more postoperative complication but amount of blood loss or in-hospital mortality was not increased. There was a tendency toward better survival in the NCCH group at 2-year follow-up (70.9% NCCH vs. 56.2% SCH, p =0.052). Conclusions: Lugol staining is useful in detecting early diseases or multiple lesions and endoscopic ultrasonography in increasing the knowledge of preoperative evaluation and thus should be recommended. Attention should be paid to more thorough lymph node dissection, especially those lymph node stations with high metastatic rates within the chest and the abdomen and meanwhile avoiding major postoperative complications, so as to improve further the accuracy of tumor staging and therapeutic outcome. Key words: thoracic esophageal carcinoma extended lymphadenectomy endoscopic ultrasonography Lugol staining INTRODUCTION Compared with other parts of the world, both Japan and China have relatively higher occurrences of esophageal cancers. Both consist mainly of squamous cell carcinomas located mostly in the thoracic esophagus, while adenocarcinoma in the distal part of the esophagus has increasingly become the major pathological type found in Europe and North America. In the past two decades, with widespread application of Lugol staining and endoscopic ultrasonography (EUS) and the introduction of extended lymph node dissection, better results have been reported by Japanese surgeons (1 6), compared either with historical data or with those from other countries. In China, as in most Western countries, esophagectomy with lymph node sampling or limited dissection still remains the mainstay of treatment and the therapeutic outcomes are similar (7,8). We present here a comparison of data from two major referral centers, the National Cancer Center Hospital (NCCH) in Japan and Shanghai Chest Hospital (SCH) in China. Our aim was to elucidate the possible differences between surgical management of thoracic esophageal carcinoma in these two countries and to shed some light on how to improve the therapeutic outcomes at institutions sharing similar concern around the world. For reprints and all correspondence: Hoichi Kato, Department of Surgery, National Cancer Center Hospital, 1 1 Tsukiji 5-chome, Chuo-ku, Tokyo , Japan. hckato@ncc.go.jp PATIENTS AND METHODS Patients treated for thoracic esophageal carcinoma by a single surgeon (H.K. at NCCH and W.C. at SCH) during January 2001 Foundation for Promotion of Cancer Research

2 204 Esophageal carcinoma in Japan and China 1997 to July 1999 were retrospectively reviewed. Only cases with a pathological type of squamous cell carcinoma and those operated on with curative intention met the selection criteria. Thus,atotalof98cases(48fromSCHand50fromNCCH) were included in this study. All patients underwent preoperative evaluation with esophagram, endoscopy and CT scans of the chest and abdomen. Preoperative staging was made according to the UICC (1997) classification (9). However, Lugol staining under endoscopy was carried out only in the NCCH group. Moreover, ultrasonography and CT scan of the neck and EUS were routinely performed in the Japanese group. The operative procedures at both centers were subtotal esophagectomy, with the upper digestive tract reconstructed with stomach tube through the retrosternal route. In the case of patients whose stomach was not available, reconstruction was made with colon through the subcutaneous route. All anastomoses were located in the neck. The major difference between the two centers lay in the extent of lymph node dissection. An extended cervical, mediastinal and abdominal (three-field) dissection, as described previously (1), was carried out routinely at NCCH. At SCH, however, this was limited to the mediastinum and the abdomen. Also, lymph nodes at the cervicothoracic junction and those along the celiac trunk, the common hepatic and the splenic artery were not dissected unless clearly visible or palpable (two-field dissection). At both centers, radiotherapy was given to patients with residual tumor after palliative resection. Some patients were also offered chemotherapy or chemoradiotherapy according to on-going clinical trials. All patients that survived operation were under follow-up. Results from the two groups were processed statistically, using the? 2 test for frequencies and grouped t-test for continuous data. Survival curves were calculated by the Kaplan Meier method and the difference between the groups was examined with a log-rank test. A p value <0.05 was considered of statistical significance. RESULTS The demographic characteristics of the two groups are listed in Table 1. The patients treated at SCH were somewhat younger than those at NCCH, including fewer cases over 70 years of age owing to a stricter indication for operation. Most patients presented with dysphagia or even chest pain at SCH with only one asymptomatic case (2.1%), whereas in the NCCH group 16 (32.0%, p < 0.001) patients showed no subjective symptoms upon presentation, all of them having superficial lesions identified under endoscopic check-up with the help of Lugol staining. Accordingly, the duration from the onset of symptoms to diagnosis of the disease was much longer in the SCH group (6.7 vs 2.3 months, p = 0.002). On the other hand, nine patients in the NCCH group were found to carry synchronous tumors in other parts of the alimentary tract, seven of them gastric cancers, one colon cancer and one hypopharyngeal cancer. Both groups had most of the tumors located in the middle part of the thoracic esophagus (see Table 1). As stated above, Table 1. Demographic and tumor characteristics SCH NCCH p Value No. % No. % Total No. of patients Gender: male/female 39/9 44/ Age (years) Duration of symptoms (months) Multiple tumors <0.001 Tumor location: Upper thoracic Mid-thoracic Lower thoracic Clinical staging: T <0.001 T T N N M M1-Lym* Stage I <0.001 Stage IIa Stage IIb Stage III Stage IV Multi-lesions *M1-Lym, distant lymph node metastasis. 12 (24%) cases in the NCCH group were diagnosed as early diseases (T 1 N 0 M 0 stage I) by EUS before operation. In the SCH group, only two (4.1%) cases were estimated as clinically T1 or stage I, both of them after neoadjuvent therapy (p < 0.001). Meanwhile, cervical lymph node involvement was suspected in three patients at NCCH, which would be considered as a contraindication to surgical treatment at SCH. Also, one or more multiple lesions in the esophagus were detected in 12 (24.0%) patients at NCCH, mainly with the help of Lugol staining under endoscopy. As this method was not routinely used at SCH, only one obvious separate lesion was noted in a single case (2.1%, p =0.006). The rate of complete resection was around 90% in both groups (see Table 2). At SCH, all reconstruction was carried out with the stomach, except in one case (2.1%) with the colon, through the retrosternal route. At NCCH, colon was used as a substitute for resected esophagus in eight (16.0%) patients; five of them received one-staged gastrectomy for concurrent cancer and the other three had had their stomach resected previously (p = 0.018). A subcutaneous route was used in 15

3 Jpn J Clin Oncol 2001;31(5) 205 Table 2. Surgical treatment of esophageal carcinoma SCH NCCH p Value No. % No. % Complete resection Stations of LN* dissected (mean): Total No <0.001 Cervical <0.001 Mediastinal <0.001 Abdominal Operation time (min) <0.001 Blood loss (ml) Morbidity: Total Leak Vocal cord paralysis Pulmonary Stenosis Wound infection Ileus Other Mortality *LN, lymph node. patients (30.0%, p < 0.001) either because of colon substitution or if the patient was considered at a high risk of leakage. It was of no surprise that significantly more stations of lymph nodes were harvested in the NCCH group, not only from the addition of cervical dissection, but also from the extended range of dissection within the chest and the abdomen (see Table 2). Accordingly, the mean operation time at NCCH was twice that at SCH. However, there was no significant difference between the amount of blood loss during operation at the two centers. Compared with SCH, significantly more postoperative complications were seen in the NCCH group (see Table 2) with morbidity rates of 41.7 and 64.0%, respectively (p = 0.027). Anastomotic leakage and vocal cord paralysis were the most common complications seen at both centers. After operation, one patient died of ileus and toxic shock at SCH and two died of empyema and a cerebral vascular event at NCCH, rendering in-hospital mortality 2.1 and 4.0%, respectively (p =0.582). In accordance with preoperative evaluation, more patients were proved to have early-stage tumors at NCCH than those at SCH (see Table 3). Although there was no significant difference in overall rate of lymph node metastasis, there tended to be more stations of lymph nodes found positive for metastasis on pathological examination at NCCH. The rates of metastases to different sites of lymph nodes are listed in Table 4. The Table 3. Pathological diagnosis SCH NCCH p Value No. % No. % Tumor invasion: T T T T LN* metastasis: N N Mean stations of LN* (+) Distant metastasis: M M1a (0.053) M1b Stage: I IIa IIb III IVa IVb Resection margin: r r Residual tumor: R R R *LN, lymph node. M0 vs M1-Lym. lymph node stations often involved (more than 10% positive rate) at both centers were the right recurrent nerve nodes, the middle paraesophageal nodes, the lower mediastinal nodes, the tracheal bifurcation and pulmonary hilar nodes, the paracardiac nodes and the left gastric artery nodes. Moreover, metastasis to cervical lymph nodes, the left recurrent nerve nodes and the infra-aortic nodes were >10% at NCCH and were almost significantly or definitely significantly higher than those at SCH. Correspondingly, eight (16.0%) patients in the NCCH group were diagnosed as M1 because of metastasis to cervical or celiac lymph nodes (M 1 -Lym) whereas this was found only in two (4.2%) patients in the SCH group (p = 0.053). Hence there was a significant difference between the pathological staging of the two groups, with more stage I, IIb

4 206 Esophageal carcinoma in Japan and China Table 4. Distribution of lymph node metastases Lymph node stations SCH NCCH p Value No. LN(+) % No. (LN+) % Neck (total No.) Left deep internal LN* Right deep internal LN Left deep external LN Right deep external LN Mediastinum (total No.) Left recurrent nerve LN Right recurrent nerve LN Superior paraesophageal LN Right paratreacheal LN Infra-aortic LN Tacheal bifurcation & pulmonary hilar LN Middle paraesophageal LN Lower mediastinal LN Diaphragmatic LN Abdomen (total No.) Paracardiac LN Lesser curvature LN Left gastric artery LN Celiac trunk, common hepatic & splenic artery LN *LN, lymph node. and IV-Lym diseases at NCCH and relatively more stage IIa and III lesions at SCH (p = 0.013). There were 14 patients at SCH and seven patients at NCCH who received radiotherapy and/or chemotherapy after operation (p = 0.113). The 1- and 2-year survival of patients who survived operation in the NCCH and the SCH groups were 89.4, 70.9% and 73.7, 56.2%, respectively (p = 0.052) (see Fig. 1). Median survival has not been reached yet in the NCCH Figure 1. Short-term survival of the two groups (p =0.052). group and in the SCH group it was 740 days. Because of the discrepancy in depth of invasion of tumors and extent of lymphadenectomy, survivals stratified according to pathological T status were further compared (see Table 5). There was a tendency toward better survival in T1 3 patientsinthencch group than those in the SCH group but the differences were not statistically significant. The 2-year survivals of T4 patients in both groups were similarly poor (20.0% vs 21.4%, p =0.711). DISCUSSION Esophageal carcinoma has been considered to carry an extremely poor prognosis, with less than 20% of the patients who could be expected showing long-term survival even after surgical resection (10,11). In Japan, extended lymph node dissection was introduced in the early 1980s. At the same time, an increasingly higher percentage of early tumors were detected, owing to the wide application of panendoscope and Lugol staining of the esophageal mucosa. With the help of EUS, tumors limited to the membranous layers without lymph Table 5. Comparison of short-term outcome stratified by pathologic T stage pt1 pt2 pt3 pt4 SCH NCCH SCH NCCH SCH NCCH SCH NCCH 1-year survival (%) year survival (%) Median survival (days) NR* NR NR NR 773 NR p Value *NR, median survival not yet reached.

5 Jpn J Clin Oncol 2001;31(5) 207 node metastasis were identified and subjected to endoscopic local resection. Patients having lesions invading into or beyond the submucosal layer would undergo esophagectomy and systemic lymphadenectomy. These approaches led to reports of 5- year survivals around the 50% level (2 5,12,13), the best results ever achieved against this once formidable disease. While there remains the argument of racial difference that might theoretically constitute a selection bias between the East and the West, this should obviously not be a major problem in the current study. Therefore, we believe that a comparison between two major referral centers in Japan and China could be made on the assumption of a similar background of tumor biology. Our results showed that there were more early-stage diseases, more cases of multiple lesions and more synchronous tumors at other parts of the digestive tract detected at NCCH. With the extension of lymph node dissection, more lymph nodes were harvested, rendered in a higher rate of metastasis, especially in certain regions. The operation time was prolonged, with elevated risk of postoperative complications. However, the mortality rate was not increased and there seemed to be a tendency toward better survival during shortterm follow-up. The 30% level of tumors found at NCCH with their depth limited to the submucosal layer is consist with other reports from Japan (5). The differences between the two groups concerning the presence and duration of symptoms upon diagnosis, as well as the result of tumor staging, reflect clearly the situation in these two countries. Routine application of Lugol staining helps to identify early superficial lesions which carries a much better prognosis, although early detection relies mainly on primary institutions rather than special referral centers as involved in this study. Besides, it may have a major role in searching for multiple lesions, be it skip metastasis (14) or multicentric carcinogenesis (15,16). Both are characteristic to the esophagus, tend to be superficial but may be of prognostic significance. Synchronous multiple tumors in the digestive tract are also a well known but often neglected condition (17). Both surgeons and radiologists or endocopists should always bear in mind the possibility of the existence of other occult tumors. Up to now, EUS has been considered the most reliable measure for non-invasive evaluation of the thoracic esophageal cancers (18,19). It can differentiate the separate layers of the esophageal wall, which is impossible on CT scan, and thus give a relatively clear knowledge about tumor invasion. Especially with superficial lesions, EUS is the only method available at present in defining the depth of tumor. Also, the lymph nodes along almost the entire length of the esophagus could be examined with EUS and evaluated not only by their size but by other indexes, such as their shapes, borders and echo types. All these aspects have given it a much higher accuracy than CT in preoperative staging (18,19). Because of the constitutional differences between the two groups in this study, comparing the accuracy in preoperative diagnosis of lymph node metastasis is inapplicable. However, the difference in the accuracy of preoperative T staging (60.4% SCH vs 78.0% NCCH, p = 0.095, not shown) indicates that the use of EUS may help improve the correctness of clinical evaluation and thereby selection of therapy (18). With the addition of cervical dissection, it was of no surprise that more stations of lymph nodes were harvested and found positive for metastasis in the NCCH group. However, it was interesting that the number of stations of lymph nodes dissected within the mediastinum or the abdomen at NCCH was also significantly higher than that at SCH. Rates of metastasis to stations dissected routinely at both centers were very similar. The right recurrent nerve nodes, the middle paraesophageal nodes, the lower mediastinal nodes, the tracheal bifurcation and pulmonary hilar nodes, the paracardiac nodes and the left gastric artery nodes had metastasis rates of >10% in both groups. However, the rate of metastasis to lymph nodes around the cardia was almost significantly higher in the NCCH group in the SCH group. Also, metastasis to the left recurrent nerve nodes and the infra-aortic nodes was >10% in the NCCH group and of significantly higher than that in the SCH group, where they were not dissected routinely. This strongly indicates that more attention be needed in these areas in the future. It has been proposed that the merit of systemic lymphadenectomy lies mainly in providing more precise staging and better chance of cure (20,21). In almost all related studies N1 disease appeared to be an important prognostic factor (19). Considering the different constitution of T staging in the current study, if lymph node metastasis is correlated with the depth of tumor invasion, as has been proved (2,6), we should expect comparatively more N1 diseases in the SCH patients. However, our results showed that it turned out to be 10% less than in the NCCH group. This was in coincidence with a nationwide study carried out in Japan comparing the results of two- and three-field lymphadenectomy, which also showed a 10% lower metastatic rate in the former group, even after stratification by location or depth of tumor invasion (6). Further, significantly more stations of lymph nodes were found to be involved in the disease on pathological examination of the NCCH group. It has been shown that the increased risk of tumor-related mortality due to lymph node metastasis might be reduced drastically with extended lymphadenectomy (20). Although there have been few prospective randomized trials comparing the outcome of systemic lymphadenectomy and lymph node sampling, a review of the literature showed that almost all reports of three-field lymphadenectomy claimed long-term survivals of ~40 50% (2 4,20), whereas a result hardly over 30% was observed after lymph node sampling. This in itself should be considered sound proof of the merit of systemic lymph node dissection. The above-mentioned nationwide study also demonstrated a significant survival advantage of extended lymphadenectomy (6). In the current study, the 1- and 2-year survivals were 15% higher in the NCCH group than in the SCH group, a difference almost statistically significant with a p value of To exclude the potential influence of stage migration caused by lymphadenectomy, we further compared

6 208 Esophageal carcinoma in Japan and China survivals stratified according to T status. Again, all survival rates at 1 or 2 years of T1 T3 diseases in the NCCH group were ~15% higher than those in the SCH group, although no statistical significance was reached owing to the small size of thestudyandtheshortdurationoffollow-up.onlyint4diseases were the results from the two groups similarly poor. Obviously surgical intervention in this setting should be questioned as there appear to be more appropriate approaches for this special group of patients (22). In this study, the morbidity after three-field lymphadenectomy at NCCH was higher than that after limited two-field dissection at SCH. Except for increased trauma due to extended dissection and consequently prolonged operation time, the higher age of the patients in the NCCH group might also be responsible. Leakage was the most commonly seen complication in both groups, but no fatal anastomosis failure occurred in either group. This is understandable as at both centers a retrosternal route was preferred and anastomosis was located high in the neck. However, the leakage rate at NCCH was more than 10% higher than that at SCH, which showed at least room for improvement. Vocal cord paralysis due to recurrent laryngeal nerve palsy ranked second in postoperative complications in patients at both centers. Apart from these, there was little difference in blood loss during operation in the two groups and the mortality rates were similarly low. All these aspects indicate that extended lymphadenectomy might carry with it a relatively higher risk but within the acceptable range. In conclusion, through the comparison between surgical management of thoracic esophageal carcinomas at two referral centers in Japan and China, certain diagnostic measures should be recommended, including Lugol staining for detecting early diseases or multiple lesions and EUS for more accurate clinical evaluation, which is of critical importance in therapeutic decision making. Also, more effort is needed in dissecting lymph nodes with a high frequency of metastasis, at least in the range of the mediastinum and the abdomen, while avoiding postoperative complications such as anastomosis leakage or recurrent laryngeal nerve palsy at the same time, so that further improvements leading to higher accuracy of tumor staging and better therapeutic outcome might be expected. References 1. Kato H, Tachimori Y, Watanabe H, Iizuka T, Terui S, Itabashi, et al. Lymph node metastasis in thoracic esophageal carcinoma. J Surg Oncol 1991;48: Akiyama H, Tsurumaru M, Udagawa H, Kajiyama Y. Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg 1994;220: Kato H, Watanabe H, Tachimori Y, Iizuka T. Evaluation of neck lymph node dissection for thoracic esophageal carcinoma. Ann Thorac Surg 1991;51: Tabira Y, Okuma T, Kondo K, Kitamura N. Indications for three-field dissection followed by esophagectomy for advanced carcinoma of the thoracic esophagus. J Thorac Cardiovasc Surg 1999;117: Japanese Society for Esophageal Diseases. Comprehensive Registry of Esophageal Cancer in Japan ( ), 1st ed. Tokyo: Japanese Society for Esophageal Diseases Isono K, Sato H, Nakayama K. Results of a nationwide study on threefield lymph node dissection of esophageal cancer. Oncology 1991;48: Zhang DW, Cheng GY, Huang GJ, Zhang RG, Lin XY, Mao YS, et al. Operable squamous esophageal carcinoma: current results from the East. World J Surg 1994;18: Watson A. Operable squamous esophageal cancer: current results from the West. World J Surg 1994;18: International Union Against Cancer. TNM Classification of Malignant Tumors, 5th ed. New York: Wiley-Liss, Earlam R, Cunha-Melo JR. Oesophageal squamous cell carcinoma I: a critical review of surgery. Br J Surg 1980;67: Muller JM, Erasmi H, Stelzner M, Zieren U, Pichlmaier H. Surgical therapy of oesophageal carcinoma. Br J Surg 1990;77: Kato H, Tachimori Y, Watanabe H, Igaki H, Nakanishi Y, Ochiai A. Recurrent esophageal carcinoma after esophagectomy with three-field lymph node dissection. J Surg Oncol 1996;61: Bhansali MS, Fujita H, Kakegawa T, Yamana H, Ono T, Hikita S, et al. Pattern of recurrence after extended radical esophagectomy with threefield lymph node dissection for squamous cell carcinoma in the thoracic esophagus. World J Surg 1997;21: Kato H, Tachimori Y, Watanabe H, Itabashi M, Hirata T, Yamaguchi H, et al. Intramural metastasis of thoracic esophageal carcinoma. Int J Cancer 1992;50: Pesko P, Rakic S, Milicevic M, Bulajic P, Gerzic Z. Prevalence and clinicopathologic features of multiple squamous cell carcinoma of the esophagus. Cancer 1994;73: Mizobuchi S, Kato H, Tachimori Y, Yamaguchi H, Itabashi M. Multiple primary carcinoma of the oesophagus. Surg Oncol 1993;2: Kato H, Tachimori Y, Watanabe H, Mizobuchi S, Igaki H, Yamaguchi H, et al. Esophageal carcinoma simultaneously associated with gastric carcinoma: analysis of clinicopathologic features and treatment. J Surg Oncol 1994;56: Rice TW, Adelstein DJ. Precise clinical staging allows treatment modification of patients with esophageal carcinoma. Oncology 1997;11(suppl 9): Reed CE. Surgical management of esophageal carcinoma. Oncologist 1999;4: Lerut T, de Leyn P, Coosemans W, van Raemdonch D, Scheys I, LeSaffre E. Surgical strategies in esophageal carcinoma with emphasis on radical lymphadenectomy. Ann Surg 1992;216: Altorki NK, Skinner DB. Occult cervical nodal metastasis in esophageal cancer: preliminary results of three-field lymphadenectomy. JThorac Cardiovasc Surg 1997;113: Ohtsu A, Boku N, Muro K, Chin K, Muto M, Yoshida S, et al. Definitive chemoradiotherapy for T4 and/or M1 lymph node squamous cell carcinoma of the esophagus. J Clin Oncol 1999;17:

A Proposed Strategy for Treatment of Superficial Carcinoma. in the Thoracic Esophagus Based on an Analysis. of Lymph Node Metastasis

A 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 information

Lymph node metastasis is one of the most important prognostic

Lymph node metastasis is one of the most important prognostic ORIGINAL ARTICLE Comparison of Survival and Recurrence Pattern Between Two-Field and Three-Field Lymph Node Dissections for Upper Thoracic Esophageal Squamous Cell Carcinoma Young Mog Shim, MD, Hong Kwan

More information

Received 16 June 2001; received in revised form 13 September 2001; accepted 13 September 2001

Received 16 June 2001; received in revised form 13 September 2001; accepted 13 September 2001 European Journal of Cardio-thoracic Surgery 20 (2001) 1089 1094 www.elsevier.com/locate/ejcts Clinicopathologic characteristics and survival of patients with clinical Stage I squamous cell carcinomas of

More information

Controversies in management of squamous esophageal cancer

Controversies 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 information

Case Scenario 1. The patient has now completed his neoadjuvant chemoradiation and has been cleared for surgery.

Case 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 information

Esophageal cancer is a significant health hazard for

Esophageal cancer is a significant health hazard for Postoperative Radiotherapy Improved Survival of Poor Prognostic Squamous Cell Carcinoma Esophagus GENERAL THORACIC Junqiang Chen, MD, Ji Zhu, MD, Jianji Pan, MD, Kunshou Zhu, MD, Xiongwei Zheng, MD, Mingqiang

More information

Chen et al. BMC Surgery 2014, 14:110

Chen et al. BMC Surgery 2014, 14:110 Chen et al. BMC Surgery 2014, 14:110 RESEARCH ARTICLE Open Access Cervical lymph node metastasis classified as regional nodal staging in thoracic esophageal squamous cell carcinoma after radical esophagectomy

More information

OCCULT CERVICAL NODAL METASTASIS IN ESOPHAGEAL CANCER: PRELIMINARY RESULTS OF THREE-FIELD LYMPHADENECTOMY

OCCULT CERVICAL NODAL METASTASIS IN ESOPHAGEAL CANCER: PRELIMINARY RESULTS OF THREE-FIELD LYMPHADENECTOMY OCCULT CERVICAL NODAL METASTASIS IN ESOPHAGEAL CANCER: PRELIMINARY RESULTS OF THREE-FIELD LYMPHADENECTOMY Nasser K. Altorki, MD David B. Skinner, MD The extent of lymphadenectomy for carcinoma of the thoracic

More information

Three-Field Lymph Node Dissection for Squamous Cell and Adenocarcinoma of the Esophagus

Three-Field Lymph Node Dissection for Squamous Cell and Adenocarcinoma of the Esophagus ANNALS OF SURGERY Vol. 236, No. 2, 177 183 2002 Lippincott Williams & Wilkins, Inc. Three-Field Lymph Node Dissection for Squamous Cell and Adenocarcinoma of the Esophagus Nasser Altorki, MD, Michael Kent,

More information

Diagnosis and Surgical Outcomes for Primary Malignant Melanoma of the Esophagus: A Single-Center Experience

Diagnosis and Surgical Outcomes for Primary Malignant Melanoma of the Esophagus: A Single-Center Experience Diagnosis and Surgical Outcomes for Primary Malignant Melanoma of the Esophagus: A Single-Center Experience Shaohua Wang, MD, Yuji Tachimori, MD, Nobukazu Hokamura, MD, Hiroyasu Igaki, MD, Takayoshi Kishino,

More information

Prognostic factors in patients with thoracic esophageal carcinoma staged pt 1-4a N 0 M 0 undergone esophagectomy with three-field lymphadenectomy

Prognostic factors in patients with thoracic esophageal carcinoma staged pt 1-4a N 0 M 0 undergone esophagectomy with three-field lymphadenectomy Original Article Page 1 of 7 Prognostic factors in patients with thoracic esophageal carcinoma staged pt 1-4a N 0 M 0 undergone esophagectomy with three-field lymphadenectomy Xiaohui Chen 1, Junqiang Chen

More information

Determining the Optimal Surgical Approach to Esophageal Cancer

Determining 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 information

Mucosal Esophageal Squamous Cell Carcinoma With Intramural Gastric Metastasis Invading Liver and Pancreas: A Case Report

Mucosal Esophageal Squamous Cell Carcinoma With Intramural Gastric Metastasis Invading Liver and Pancreas: A Case Report Int Surg 2014;99:458 462 DOI: 10.9738/INTSURG-D-13-00069.1 Case Report Mucosal Esophageal Squamous Cell Carcinoma With Intramural Gastric Metastasis Invading Liver and Pancreas: A Case Report Nobuhiro

More information

Characteristics and prognostic factors of synchronous multiple primary esophageal carcinoma: A report of 52 cases

Characteristics and prognostic factors of synchronous multiple primary esophageal carcinoma: A report of 52 cases Thoracic Cancer ISSN 1759-7706 ORIGINAL ARTICLE Characteristics and prognostic factors of synchronous multiple primary esophageal carcinoma: A report of 52 cases Mei Li & Zhi-xiong Lin Department of Radiation

More information

The lymph nodes (LNs) around the recurrent laryngeal

The lymph nodes (LNs) around the recurrent laryngeal GENERAL THORACIC A Strategy for Supraclavicular Lymph Node Dissection Using Recurrent Laryngeal Nerve Lymph Node Status in Thoracic Esophageal Squamous Cell Carcinoma Yusuke Taniyama, MD, Takanobu Nakamura,

More information

GTS. Abbreviation and Acronym UICC ¼ Union for International Cancer Control

GTS. Abbreviation and Acronym UICC ¼ Union for International Cancer Control General Thoracic Surgery Tachimori et al Supraclavicular node metastasis from thoracic esophageal carcinoma: A surgical series from a Japanese multi-institutional nationwide registry of esophageal cancer

More information

Minimally 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 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 information

Abstracting 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 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 information

Esophageal cancer is one of the most malignant tumors,

Esophageal cancer is one of the most malignant tumors, Patterns of Lymph Node Metastasis and Survival for Upper Esophageal Squamous Cell Carcinoma Hee-Jin Jang, MD,* Hyun-Sung Lee, MD, PhD,* Moon Soo Kim, MD, Jong Mog Lee, MD, and Jae Ill Zo, MD, PhD Center

More information

Characteristics of intramural metastasis in gastric cancer. Tatsuya Hashimoto Kuniyoshi Arai Yuichi Yamashita Yoshiaki Iwasaki Tsunekazu

Characteristics of intramural metastasis in gastric cancer. Tatsuya Hashimoto Kuniyoshi Arai Yuichi Yamashita Yoshiaki Iwasaki Tsunekazu ORIGINAL ARTICLE Characteristics of intramural metastasis in gastric cancer Tatsuya Hashimoto Kuniyoshi Arai Yuichi Yamashita Yoshiaki Iwasaki Tsunekazu Hishima Author for correspondence: T. Hashimoto

More information

Lymph node dissection for lung cancer is both an old

Lymph node dissection for lung cancer is both an old LOBE-SPECIFIC EXTENT OF SYSTEMATIC LYMPH NODE DISSECTION FOR NON SMALL CELL LUNG CARCINOMAS ACCORDING TO A RETROSPECTIVE STUDY OF METASTASIS AND PROGNOSIS Hisao Asamura, MD Haruhiko Nakayama, MD Haruhiko

More information

Yuanli Dong 1,2, Hui Guan 1,2, Wei Huang 1, Zicheng Zhang 1, Dongbo Zhao 3, Yang Liu 1,3, Tao Zhou 1, Baosheng Li 1.

Yuanli Dong 1,2, Hui Guan 1,2, Wei Huang 1, Zicheng Zhang 1, Dongbo Zhao 3, Yang Liu 1,3, Tao Zhou 1, Baosheng Li 1. Original Article Precise delineation of clinical target volume for crossingsegments thoracic esophageal squamous cell carcinoma based on the pattern of lymph node metastases Yuanli Dong 1,2, Hui Guan 1,2,

More information

Lung cancer is a major cause of cancer deaths worldwide.

Lung cancer is a major cause of cancer deaths worldwide. ORIGINAL ARTICLE Prognostic Factors in 3315 Completely Resected Cases of Clinical Stage I Non-small Cell Lung Cancer in Japan Teruaki Koike, MD,* Ryosuke Tsuchiya, MD, Tomoyuki Goya, MD, Yasunori Sohara,

More information

The right middle lobe is the smallest lobe in the lung, and

The 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 information

Successful Resection of Esophageal Carcinoma Associated with Double Aortic Arch: A Case Report

Successful Resection of Esophageal Carcinoma Associated with Double Aortic Arch: A Case Report Successful Resection of Esophageal Carcinoma Associated with Double Aortic Arch: A Case Report NAOSHI KUBO 1, MASAICHI OHIRA 1, YOSHITO YAMASHITA 2, KATSUNOBU SAKURAI 1, HIROAKI TANAKA 1, KAZUYA MUGURUMA

More information

Case Scenario year-old white male presented to personal physician with dyspepsia with reflux.

Case 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 information

Surgical strategies in esophageal cancer

Surgical strategies in esophageal cancer Gastro-Conference Berlin 2005 October 1-2, 2005 Surgical strategies in esophageal cancer J. Rüdiger Siewert Department of Surgery, Klinikum rechts der Isar Technische Universität München Esophageal Cancer

More information

Surgical Problems in Proximal GI Cancer Management Cardia Tumours Question #1: What are cardia tumours?

Surgical Problems in Proximal GI Cancer Management Cardia Tumours Question #1: What are cardia tumours? Surgical Problems in Proximal GI Cancer Management Cardia Tumours Question #1: What are cardia tumours? Question #2: How are cardia tumours managed? Michael F. Humer December 3, 2005 Vancouver, BC Case

More information

Lung cancer pleural invasion was recognized as a poor prognostic

Lung cancer pleural invasion was recognized as a poor prognostic Visceral pleural invasion classification in non small cell lung cancer: A proposal on the basis of outcome assessment Kimihiro Shimizu, MD a Junji Yoshida, MD a Kanji Nagai, MD a Mitsuyo Nishimura, MD

More information

Pattern of lymphatic spread in thoracic esophageal squamous cell carcinoma: A single-institution experience

Pattern of lymphatic spread in thoracic esophageal squamous cell carcinoma: A single-institution experience GENERAL THORACIC SURGERY Pattern of lymphatic spread in thoracic esophageal squamous cell carcinoma: A single-institution experience Bin Li, MD, a,b Haiquan Chen, MD, a,b Jiaqing Xiang, MD, a,b Yawei Zhang,

More information

Esophageal carcinoma is one of the most tedious

Esophageal carcinoma is one of the most tedious Subcarinal Node Metastasis in Thoracic Esophageal Squamous Cell Carcinoma Jingeng Liu, MD,* YiHu,MD,* Xuan Xie, MD, and Jianhua Fu, MD Department of Thoracic Oncology, Cancer Center, Sun Yat-sen University,

More information

Metachronous pulmonary metastasis after radical esophagectomy for esophageal cancer: prognosis and outcome

Metachronous pulmonary metastasis after radical esophagectomy for esophageal cancer: prognosis and outcome Takemura et al. Journal of Cardiothoracic Surgery 2012, 7:103 RESEARCH ARTICLE Open Access Metachronous pulmonary metastasis after radical esophagectomy for esophageal cancer: prognosis and outcome Masashi

More information

Prognostic Significance of Extranodal Cancer Invasion of Mediastinal Lymph Nodes in Lung Cancer

Prognostic Significance of Extranodal Cancer Invasion of Mediastinal Lymph Nodes in Lung Cancer Jpn. J. Clin. Oncol. 198, 1 (), 7-1 Prognostic Significance of Extranodal Cancer Invasion of Mediastinal Lymph Nodes in Lung Cancer KEIICHI SUEMASU, M.D. AND TSUGUO NARUKE, M.D. Department of Surgery,

More information

Three-field lymph node dissection in esophageal cancer surgery

Three-field lymph node dissection in esophageal cancer surgery Review Article Three-field lymph node dissection in esophageal cancer surgery Satoru Matsuda 1, Hiroya Takeuchi 1,2, Hirofumi Kawakubo 1, Yuko Kitagawa 1 1 Department of Surgery, Keio University School

More information

Hong-Yao Xu *, Sheng-Xi Wu, He-San Luo, Chu-Yun Chen, Lian-Xing Lin and He-Cheng Huang

Hong-Yao Xu *, Sheng-Xi Wu, He-San Luo, Chu-Yun Chen, Lian-Xing Lin and He-Cheng Huang Xu et al. Radiation Oncology (2018) 13:200 https://doi.org/10.1186/s13014-018-1145-4 RESEARCH Open Access Analysis of definitive chemo-radiotherapy for esophageal cancer with supra-clavicular node metastasis

More information

Clinical study on postoperative recurrence in patients with pn0 esophageal squamous cell carcinoma

Clinical study on postoperative recurrence in patients with pn0 esophageal squamous cell carcinoma Guo et al. Journal of Cardiothoracic Surgery 2014, 9:150 RESEARCH ARTICLE Open Access Clinical study on postoperative recurrence in patients with pn0 esophageal squamous cell carcinoma Xu-feng Guo, Teng

More information

Significance of the lymph nodes in the 7th station in rational dissection for metastasis of distal gastric cancer with different T categories

Significance of the lymph nodes in the 7th station in rational dissection for metastasis of distal gastric cancer with different T categories Original Article Significance of the lymph nodes in the 7th station in rational dissection for metastasis of distal gastric cancer with different T categories Wu Song, Yulong He, Shaochuan Wang, Weiling

More information

Radiation Therapy for Recurrent Esophageal Cancer after Surgery: Clinical Results and Prognostic Factors

Radiation Therapy for Recurrent Esophageal Cancer after Surgery: Clinical Results and Prognostic Factors Radiation Therapy for Recurrent Esophageal Cancer after Surgery: Clinical Results and Prognostic Factors Yoshiyuki Shioyama 1, Katsumasa Nakamura 1, Saiji Ohga 1, Satoshi Nomoto 1, Tomonari Sasaki 1, Toshihiro

More information

Efficacy of intraoperative radiotherapy targeted to the abdominal lymph node area in patients with esophageal carcinoma

Efficacy of intraoperative radiotherapy targeted to the abdominal lymph node area in patients with esophageal carcinoma Journal of Radiation Research Advance Access published August 7, 2012 Journal of Radiation Research, 2012, 00, 1 10 doi: 10.1093/jrr/rrs045 Regular Paper Efficacy of intraoperative radiotherapy targeted

More information

The Learning Curve for Minimally Invasive Esophagectomy

The 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 information

INTRODUCTION. Jpn J Clin Oncol 2006;36(12) doi: /jjco/hyl105

INTRODUCTION. Jpn J Clin Oncol 2006;36(12) doi: /jjco/hyl105 The Range of Tumor Extension Should Have Precedence over the Location of the Deepest Tumor Center in Determining the Regional Lymph Node Grouping for Widely Extending Esophageal Carcinomas Jpn J Clin Oncol

More information

SETTING Fudan University Shanghai Cancer Center. RESPONSIBLE PARTY Haiquan Chen MD.

SETTING 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 information

Katsuro Sato. Department of Speech, Language and Hearing Sciences, Niigata University of Health and Welfare, Niigata, Japan

Katsuro Sato. Department of Speech, Language and Hearing Sciences, Niigata University of Health and Welfare, Niigata, Japan Report Niigata Journal of Health and Welfare Vol. 12, No. 1 Retrospective analysis of head and neck cancer cases from the database of the Niigata Prefecture Head and Neck Malignant Tumor Registration Committee

More information

Long-term Follow-up for Patients with Papillary Thyroid Carcinoma Treated as Benign Nodules

Long-term Follow-up for Patients with Papillary Thyroid Carcinoma Treated as Benign Nodules Long-term Follow-up for Patients with Papillary Thyroid Carcinoma Treated as Benign Nodules YASUHIRO ITO, TAKUYA HIGASHIYAMA, YUUKI TAKAMURA, AKIHIRO MIYA, KAORU KOBAYASHI, FUMIO MATSUZUKA, KANJI KUMA

More information

MINIMALLY INVASIVE ESOPHAGECTOMY FOR CANCER: where do we stand?

MINIMALLY INVASIVE ESOPHAGECTOMY FOR CANCER: where do we stand? MINIMALLY INVASIVE ESOPHAGECTOMY FOR CANCER: where do we stand? Ph Nafteux, MD Copenhagen, Nov 3rd 2011 Department of Thoracic Surgery, University Hospitals Leuven, Belgium W. Coosemans, H. Decaluwé, Ph.

More information

Superior and Basal Segment Lung Cancers in the Lower Lobe Have Different Lymph Node Metastatic Pathways and Prognosis

Superior and Basal Segment Lung Cancers in the Lower Lobe Have Different Lymph Node Metastatic Pathways and Prognosis ORIGINAL ARTICLES: Superior and Basal Segment Lung Cancers in the Lower Lobe Have Different Lymph Node Metastatic Pathways and Prognosis Shun-ichi Watanabe, MD, Kenji Suzuki, MD, and Hisao Asamura, MD

More information

Limited en bloc Resection of the Gastroesophageal Junction with Isoperistaltic Jejunal Interposition

Limited en bloc Resection of the Gastroesophageal Junction with Isoperistaltic Jejunal Interposition 22 Limited en bloc Resection of the Gastroesophageal Junction with Isoperistaltic Jejunal Interposition J.R. Izbicki, W.T. Knoefel, D. C. Broering ] Indications Severe dysplasia in the distal esophagus

More information

Yuji Tachimori. Introduction

Yuji Tachimori. Introduction Review Article Pattern of lymph node metastases of squamous cell esophageal cancer based on the anatomical lymphatic drainage system: efficacy of lymph node dissection according to tumor location Yuji

More information

REVIEW ARTICLE. Extended Esophagectomy With 3-Field Lymph Node Dissection for Esophageal Cancer

REVIEW ARTICLE. Extended Esophagectomy With 3-Field Lymph Node Dissection for Esophageal Cancer REVIEW ARTICLE Extended Esophagectomy With 3-Field Lymph Node Dissection for Esophageal Cancer Mitsuo Tachibana, MD; Shoichi Kinugasa, MD; Hiroshi Yoshimura, MD; Dipok Kumar Dhar, MD; Naofumi Nagasue,

More information

Carcinogenesis and treatment of adenocarcinoma of the oesophagus and gastric cardia Hulscher, J.B.F.

Carcinogenesis and treatment of adenocarcinoma of the oesophagus and gastric cardia Hulscher, J.B.F. UvA-DARE (Digital Academic Repository) Carcinogenesis and treatment of adenocarcinoma of the oesophagus and gastric cardia Hulscher, J.B.F. Link to publication Citation for published version (APA): Hulscher,

More information

Comparison of complete and minimal mediastinal lymph node dissection for non-small cell lung cancer: Results of a prospective randomized trial

Comparison of complete and minimal mediastinal lymph node dissection for non-small cell lung cancer: Results of a prospective randomized trial Thoracic Cancer ISSN 1759-7706 ORIGINAL ARTICLE Comparison of complete and minimal mediastinal lymph node dissection for non-small cell lung cancer: Results of a prospective randomized trial Junhua Zhang*,

More information

Prognostic Factors for Survival of Stage IB Upper Lobe Non-small Cell Lung Cancer Patients: A Retrospective Study in Shanghai, China

Prognostic Factors for Survival of Stage IB Upper Lobe Non-small Cell Lung Cancer Patients: A Retrospective Study in Shanghai, China www.springerlink.com Chin J Cancer Res 23(4):265 270, 2011 265 Original Article Prognostic Factors for Survival of Stage IB Upper Lobe Non-small Cell Lung Cancer Patients: A Retrospective Study in Shanghai,

More information

Robotic-assisted McKeown esophagectomy

Robotic-assisted McKeown esophagectomy Case Report Page 1 of 8 Robotic-assisted McKeown esophagectomy Dingpei Han, Su Yang, Wei Guo, Runsen Jin, Yajie Zhang, Xingshi Chen, Han Wu, Hailei Du, Kai Chen, Jie Xiang, Hecheng Li Department of Thoracic

More information

Satisfactory surgical outcome of T2 gastric cancer after modified D2 lymphadenectomy

Satisfactory surgical outcome of T2 gastric cancer after modified D2 lymphadenectomy Original Article Satisfactory surgical outcome of T2 gastric cancer after modified D2 lymphadenectomy Shupeng Zhang 1, Liangliang Wu 2, Xiaona Wang 2, Xuewei Ding 2, Han Liang 2 1 Department of General

More information

Esophageal cancer: Biology, natural history, staging and therapeutic options

Esophageal 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 information

The CROSS road in neoadjuvant therapy for esophageal cancer: long-term results of CROSS trial

The CROSS road in neoadjuvant therapy for esophageal cancer: long-term results of CROSS trial Editorial The CROSS road in neoadjuvant therapy for esophageal cancer: long-term results of CROSS trial Ian Wong, Simon Law Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery,

More information

Quiz Adenocarcinoma of the distal stomach has been increasing in the last 20 years. a. True b. False

Quiz Adenocarcinoma of the distal stomach has been increasing in the last 20 years. a. True b. False Quiz 1 1. Which of the following are risk factors for esophagus cancer. a. Obesity b. Gastroesophageal reflux c. Smoking and Alcohol d. All of the above 2. Adenocarcinoma of the distal stomach has been

More information

Although esophagectomy remains the standard of care for esophageal

Although esophagectomy remains the standard of care for esophageal Keresztes et al General Thoracic Surgery Preoperative chemotherapy for esophageal cancer with paclitaxel and carboplatin: Results of a phase II trial R. S. Keresztes, MD J. L. Port, MD M. W. Pasmantier,

More information

Determining the optimal number of lymph nodes harvested during esophagectomy

Determining the optimal number of lymph nodes harvested during esophagectomy Original Article Determining the optimal number of lymph nodes harvested during esophagectomy Khaldoun Almhanna, Jill Weber, Ravi Shridhar, Sarah Hoffe, Jonathan Strosberg, Kenneth Meredith Department

More information

Clinicopathologic and prognostic factors of young and elderly patients with esophageal adenocarcinoma: is there really a difference?

Clinicopathologic and prognostic factors of young and elderly patients with esophageal adenocarcinoma: is there really a difference? Diseases of the Esophagus (2008) 21, 596 600 DOI: 10.1111/j.1442-2050.2008.00817.x Original article Clinicopathologic and prognostic factors of young and elderly patients with esophageal adenocarcinoma:

More information

Appendix 1: Regional Lymph Node Stations for Staging Esophageal Cancer

Appendix 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 information

Treatment Results of Radical Surgery and Definitive Chemoradiotherapy for Patients with Submucosal Esophageal Squamous Cell Cancinomas

Treatment Results of Radical Surgery and Definitive Chemoradiotherapy for Patients with Submucosal Esophageal Squamous Cell Cancinomas Treatment Results of Radical Surgery and Definitive Chemoradiotherapy for Patients with Submucosal Esophageal Squamous Cell Cancinomas YASUSHI TOH 1, TAKEFUMI OHGA 1, SHUHEI ITOH 1, AKIRA KABASHIMA 1,

More information

B Breast cancer, managing risk of lobular, in hereditary diffuse gastric cancer, 51

B Breast cancer, managing risk of lobular, in hereditary diffuse gastric cancer, 51 Index Note: Page numbers of article titles are in boldface type. A Adenocarcinoma, gastric. See also Gastric cancer. D2 nodal dissection for 57 70 Adjuvant therapy, for gastric cancer, impact of D2 dissection

More information

Esophageal cancer (EC) is the eighth most common cancer worldwide and the sixth most common cause of cancer-related mortality (Kamangar et al.

Esophageal cancer (EC) is the eighth most common cancer worldwide and the sixth most common cause of cancer-related mortality (Kamangar et al. Arch. Biol. Sci., Belgrade, 65 (3), 821-827, 2013 DOI:10.2298/ABS1303821L DETERMINING THE LYMPH NODE CLINICAL TARGET VOLUME OF UPPER ESOPHAGEAL CARCINOMA WITH COMPUTED TOMOGRAPHY MINGHUAN LI 1, YUHUI LIU

More information

In 1989, Deslauriers et al. 1 described intrapulmonary metastasis

In 1989, Deslauriers et al. 1 described intrapulmonary metastasis ORIGINAL ARTICLE Prognosis of Resected Non-Small Cell Lung Cancer Patients with Intrapulmonary Metastases Kanji Nagai, MD,* Yasunori Sohara, MD, Ryosuke Tsuchiya, MD, Tomoyuki Goya, MD, and Etsuo Miyaoka,

More information

Pattern of Recurrence Following Complete Resection of Esophageal Carcinoma and Factors Predictive of Recurrent Disease

Pattern of Recurrence Following Complete Resection of Esophageal Carcinoma and Factors Predictive of Recurrent Disease 1616 Pattern of Recurrence Following Complete Resection of Esophageal Carcinoma and Factors Predictive of Recurrent Disease Christophe Mariette, M.D. 1,2 Jean-Michel Balon, M.D. 1 Guillaune Piessen, M.D.

More information

Management of Esophageal Cancer: Evidence Based Review of Current Guidelines. Madhuri Rao, MD PGY-5 SUNY Downstate Medical Center

Management of Esophageal Cancer: Evidence Based Review of Current Guidelines. Madhuri Rao, MD PGY-5 SUNY Downstate Medical Center Management of Esophageal Cancer: Evidence Based Review of Current Guidelines Madhuri Rao, MD PGY-5 SUNY Downstate Medical Center Case Presentation 68 y/o male PMH: NIDDM, HTN, hyperlipidemia, CAD s/p stents,

More information

Log odds of positive lymph nodes is a novel prognostic indicator for advanced ESCC after surgical resection

Log odds of positive lymph nodes is a novel prognostic indicator for advanced ESCC after surgical resection Original Article Log odds of positive lymph nodes is a novel prognostic indicator for advanced ESCC after surgical resection Mingjian Yang 1,2, Hongdian Zhang 1,2, Zhao Ma 1,2, Lei Gong 1,2, Chuangui Chen

More information

doi: /j.ijrobp

doi: /j.ijrobp doi:10.1016/j.ijrobp.2010.08.037 Int. J. Radiation Oncology Biol. Phys., Vol. 82, No. 1, pp. 475 482, 2012 Copyright Ó 2012 Elsevier Inc. Printed in the USA. All rights reserved 0360-3016/$ - see front

More information

MEDIASTINAL STAGING surgical pro

MEDIASTINAL STAGING surgical pro MEDIASTINAL STAGING surgical pro Paul E. Van Schil, MD, PhD Department of Thoracic and Vascular Surgery University of Antwerp, Belgium Mediastinal staging Invasive techniques lymph node mapping cervical

More information

Prognosis of Patients With Gastric Cancer Who Underwent Proximal Gastrectomy

Prognosis of Patients With Gastric Cancer Who Underwent Proximal Gastrectomy Int Surg 2012;97:275 279 Prognosis of Patients With Gastric Cancer Who Underwent Proximal Gastrectomy Masahide Ikeguchi, Abdul Kader, Seigo Takaya, Youji Fukumoto, Tomohiro Osaki, Hiroaki Saito, Shigeru

More information

Aliu Sanni MD SUNY Downstate Medical Center August 16, 2012

Aliu 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 information

MUSCLE-INVASIVE AND METASTATIC BLADDER CANCER

MUSCLE-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 information

Index. Note: Page numbers of article titles are in boldface type.

Index. Note: Page numbers of article titles are in boldface type. Note: Page numbers of article titles are in boldface type. A Adenocarcinoma, pancreatic ductal, laparoscopic distal pancreatectomy for, 61 Adrenal cortical carcinoma, laparoscopic adrenalectomy for, 114

More information

Evaluation of the 7 th edition of the UICC-AJCC tumor, node, metastasis classification for esophageal cancer in a Chinese cohort

Evaluation of the 7 th edition of the UICC-AJCC tumor, node, metastasis classification for esophageal cancer in a Chinese cohort Original Article Evaluation of the 7 th edition of the UICC-AJCC tumor, node, metastasis classification for esophageal cancer in a Chinese cohort Yan Huang 1 *, Weigang Guo 2 *, Shiming Shi 1, Jian He

More information

MUSCLE - INVASIVE AND METASTATIC BLADDER CANCER

MUSCLE - 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 information

Prognostic and Clinical Evaluation of Axillary Lymph Node Metastasis in Esophageal Cancer

Prognostic and Clinical Evaluation of Axillary Lymph Node Metastasis in Esophageal Cancer Prognostic and Clinical Evaluation of Axillary Lymph Node Metastasis in Esophageal Cancer Shuhei Komatsu 1, Yuji Ueda 1, Daisuke Ichikawa 1, Hitoshi Fujiwara 1, Kazuma Okamoto 1, Shojiro Kikuchi 1, Atsushi

More information

ABSTRACT INTRODUCTION

ABSTRACT INTRODUCTION /, 2017, Vol. 8, (No. 25), pp: 41563-41571 Proposed modifications of supraclavicular lymph node metastasis in the esophageal squamous cell carcinoma staging system for improved survival stratification

More information

Mediastinal Staging. Samer Kanaan, M.D.

Mediastinal 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 information

Correspondence to: Jiankun Hu, MD, PhD. Department of Gastrointestinal Surgery; Institute of Gastric Cancer, State Key Laboratory of.

Correspondence to: Jiankun Hu, MD, PhD. Department of Gastrointestinal Surgery; Institute of Gastric Cancer, State Key Laboratory of. Original Article Comparison of survival outcomes between transthoracic and transabdominal surgical approaches in patients with Siewert-II/III esophagogastric junction adenocarcinoma: a single-institution

More information

Treatment of oligometastatic NSCLC

Treatment of oligometastatic NSCLC Treatment of oligometastatic NSCLC Jarosław Kużdżał Department of Thoracic Surgery Jagiellonian University Collegium Medicum, John Paul II Hospital, Cracow New idea? 14 NSCLC patients with solitary extrathoracic

More information

Minimally Invasive Esophagectomy: OVERRATED!!! Sagar Damle UCHSC December 11, 2006

Minimally Invasive Esophagectomy: OVERRATED!!! Sagar Damle UCHSC December 11, 2006 Minimally Invasive Esophagectomy: OVERRATED!!! Sagar Damle UCHSC December 11, 2006 Esophageal Cancer - Est. 15,000 cases in 2006 - Est. 14,000 deaths - Overall 5-year survival: 15.6% - 33.6 % for local

More information

MEDIASTINAL LYMPH NODE METASTASIS IN PATIENTS WITH CLINICAL STAGE I PERIPHERAL NON-SMALL-CELL LUNG CANCER

MEDIASTINAL LYMPH NODE METASTASIS IN PATIENTS WITH CLINICAL STAGE I PERIPHERAL NON-SMALL-CELL LUNG CANCER MEDIASTINAL LYMPH NODE METASTASIS IN PATIENTS WITH CLINICAL STAGE I PERIPHERAL NON-SMALL-CELL LUNG CANCER Tsuneyo Takizawa, MD a Masanori Terashima, MD a Teruaki Koike, MD a Hideki Akamatsu, MD a Yuzo

More information

Clinicopathological Characteristics and Outcome Indicators of Stage II Gastric Cancer According to the Japanese Classification of Gastric Cancer

Clinicopathological Characteristics and Outcome Indicators of Stage II Gastric Cancer According to the Japanese Classification of Gastric Cancer Clinicopathological Characteristics and Outcome Indicators of Stage II Gastric Cancer According to the Japanese Classification of Gastric Cancer HITOSHI OJIMA 1, KEN-ICHIRO ARAKI 1, TOSHIHIDE KATO 1, KAORI

More information

Chirurgie beim oligo-metastatischen NSCLC

Chirurgie beim oligo-metastatischen NSCLC 24. Ärzte-Fortbildungskurs in Klinischer Onkologie 20.-22. Februar 2014, Kantonsspital St. Gallen Chirurgie beim oligo-metastatischen NSCLC Prof. Dr. med. Walter Weder Klinikdirektor Thoraxchirurgie, UniversitätsSpital

More information

Impact of infectious complications on gastric cancer recurrence

Impact of infectious complications on gastric cancer recurrence Gastric Cancer (2015) 18:368 374 DOI 10.1007/s10120-014-0361-3 ORIGINAL ARTICLE Impact of infectious complications on gastric cancer recurrence Tsutomu Hayashi Takaki Yoshikawa Toru Aoyama Shinichi Hasegawa

More information

Present State of Therapeutic Strategies for Thoracic Surgical Diseases in Japan

Present State of Therapeutic Strategies for Thoracic Surgical Diseases in Japan From the Japanese Association of Medical Sciences The Japanese Association for Thoracic Surgery Present State of Therapeutic Strategies for Thoracic Surgical Diseases in Japan JMAJ 52(2): 117 121, 2009

More information

The accurate assessment of lymph node involvement is

The accurate assessment of lymph node involvement is ORIGINAL ARTICLE Which is the Better Prognostic Factor for Resected Non-small Cell Lung Cancer The Number of Metastatic Lymph Nodes or the Currently Used Nodal Stage Classification? Shenhai Wei, MD, PhD,*

More information

Clinical Evaluation of Low-dose Cisplatin and 5-Fluorouracil as Adjuvant Chemoradiotherapy for Advanced Squamous Cell Carcinoma of the Esophagus

Clinical Evaluation of Low-dose Cisplatin and 5-Fluorouracil as Adjuvant Chemoradiotherapy for Advanced Squamous Cell Carcinoma of the Esophagus Hiroshima J. Med. Sci. Vol. 54, No. 3, 67-71, September, 25 HIJM54-11 67 Clinical Evaluation of Low-dose Cisplatin and 5-Fluorouracil as Adjuvant Chemoradiotherapy for Advanced Squamous Cell Carcinoma

More information

Di Lu 1#, Xiguang Liu 1#, Mei Li 1#, Siyang Feng 1#, Xiaoying Dong 1, Xuezhou Yu 2, Hua Wu 1, Gang Xiong 1, Ruijun Cai 1, Guoxin Li 3, Kaican Cai 1

Di Lu 1#, Xiguang Liu 1#, Mei Li 1#, Siyang Feng 1#, Xiaoying Dong 1, Xuezhou Yu 2, Hua Wu 1, Gang Xiong 1, Ruijun Cai 1, Guoxin Li 3, Kaican Cai 1 Case Report Three-port mediastino-laparoscopic esophagectomy (TPMLE) for an 81-year-old female with early-staged esophageal cancer: a case report of combining single-port mediastinoscopic esophagectomy

More information

Mouth & Body Current information about medical-dental cooperative clinical practices for cancer patients

Mouth & Body Current information about medical-dental cooperative clinical practices for cancer patients Mouth & Body body. Topics A healthy mouth leads to a sound VOL.2 Current information about medical-dental cooperative clinical practices for cancer patients Yasuhiro Tsubosa, MD, PhD Chief of Division

More information

Risk factors for lymph node metastasis in histologically poorly differentiated type early gastric cancer

Risk factors for lymph node metastasis in histologically poorly differentiated type early gastric cancer 498 Original article Risk factors for lymph node metastasis in histologically poorly differentiated type early gastric cancer Authors C. Kunisaki 1, M. Takahashi 2, Y. Nagahori 3, T. Fukushima 3, H. Makino

More information

Transhiatal Esophagectomy: Lower Mortality, Diminished Morbidity, Equal Effectiveness

Transhiatal Esophagectomy: Lower Mortality, Diminished Morbidity, Equal Effectiveness Transhiatal Esophagectomy: Lower Mortality, Diminished Morbidity, Equal Effectiveness Sunil Malhotra, M.D. Department of Surgery University of Colorado Resident Debate April 30, 2007 Esophageal Cancer

More information

Impact of esophageal cancer staging on overall survival and disease-free survival based on the 2010 AJCC classification by lymph nodes

Impact of esophageal cancer staging on overall survival and disease-free survival based on the 2010 AJCC classification by lymph nodes Journal of Radiation Research, 2013, 54, 307 314 doi: 10.1093/jrr/rrs096 Advance Access Publication 2 November 2012 Impact of esophageal cancer staging on overall survival and disease-free survival based

More information

Parameters Linked to Ten-Year Survival in Japan of Resected Esophageal Carcinoma

Parameters Linked to Ten-Year Survival in Japan of Resected Esophageal Carcinoma Parameters Linked to Ten-Year Survival in Japan of Resected Esophageal Carcinoma Japanese Committee for Registration ofesophageal Carcinoma Cases Chairman: Toshifumi lizuka, M.D.* Members: Kaichi lsono,

More information

The 8th Edition Lung Cancer Stage Classification

The 8th Edition Lung Cancer Stage Classification The 8th Edition Lung Cancer Stage Classification Elwyn Cabebe, M.D. Medical Oncology, Hematology, and Hospice and Palliative Care Valley Medical Oncology Consultants Director of Quality, Medical Oncology

More information

Prognostic significance of metastatic lymph node ratio: the lymph node ratio could be a prognostic indicator for patients with gastric cancer

Prognostic significance of metastatic lymph node ratio: the lymph node ratio could be a prognostic indicator for patients with gastric cancer Hou et al. World Journal of Surgical Oncology (2018) 16:198 https://doi.org/10.1186/s12957-018-1504-5 REVIEW Open Access Prognostic significance of metastatic lymph node ratio: the lymph node ratio could

More information

Ji-Feng Feng 1,2*, Ying Huang 3 and Qi-Xun Chen 1,2 WORLD JOURNAL OF SURGICAL ONCOLOGY

Ji-Feng Feng 1,2*, Ying Huang 3 and Qi-Xun Chen 1,2 WORLD JOURNAL OF SURGICAL ONCOLOGY Feng et al. World Journal of Surgical Oncology 2014, 12:58 WORLD JOURNAL OF SURGICAL ONCOLOGY RESEARCH Open Access Preoperative platelet lymphocyte ratio (PLR) is superior to neutrophil lymphocyte ratio

More information

The 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 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 information