Background A regimen of epirubicin, cisplatin, and infused fluorouracil (ECF) improves survival among patients with incurable locally advanced or metastatic gastric adenocarcinoma. We assessed whether the addition of a perioperative regimen of ECF to surgery improves outcomes among patients with potentially curable gastric cancer. Methods We randomly assigned patients with resectable adenocarcinoma of the stomach, esophagogastric junction, or lower esophagus to either perioperative chemotherapy and surgery (250 patients) or surgery alone (253 patients). Chemotherapy consisted of three preoperative and three postoperative cycles of intravenous epirubicin (50 mg per square meter of body-surface area) and cisplatin (60 mg per square meter) on day 1, and a continuous intravenous infusion of fluorouracil (200 mg per square meter per day) for 21 days. The primary end point was overall survival. Results ECF-related adverse effects were similar to those previously reported among patients with advanced gastric cancer. Rates of postoperative complications were similar in the perioperative-chemotherapy group and the surgery group (46 percent and 45 percent, respectively), as were the numbers of deaths within 30 days after surgery. The resected tumors were significantly smaller and less advanced in the perioperative-chemotherapy group. With a median follow-up of four years, 149 patients in the perioperative-chemotherapy group and 170 in the surgery group had died. As compared with the surgery group, the perioperative-chemotherapy group had a higher likelihood of overall survival (hazard ratio for death, 0.75; 95 percent confidence interval, 0.60 to 0.93; P = 0.009; five-year survival rate, 36 percent vs. 23 percent) and of progression-free survival (hazard ratio for progression, 0.66; 95 percent confidence interval, 0.53 to 0.81; P<0.001). Conclusions In patients with operable gastric or lower esophageal adenocarcinomas, a perioperative regimen of ECF decreased tumor size and stage and significantly improved progression-free and overall survival. (Current Controlled Trials number, ISRCTN93793971.)

/pdf/perioperative-chemotherapy-versus-surgery-alone-for-5bm4upx1bz.pdf

Perioperative Chemotherapy versus Surgery Alone for Resectable Gastroesophageal Cancer

https://www.chpso.org/sites/main/files/file-attachments/chest-2008-geerts-381s-453s.pdf

Prevention of Venous Thromboembolism* American College of Chest Physicians Evidence- Based Clinical Practice Guidelines (8th Edition)

Sepsis is the leading cause of death in critically ill patients in the United States. Yet the individual host response to septicemia is variable, depending on the patient's immune response, age, nutritional status, and coexisting conditions, as well as on the virulence of the organism and the size of the inoculum. This review examines evolving concepts of sepsis and discusses new and potential therapies. Recent clinical advances include therapy with activated protein C, stringent control of blood glucose, and early goal-directed therapy to treat cellular oxygen deficit. Future therapies may be focused on modulating the immune response in the light of the characteristics of the specific pathogen, the genetic profile of the patient, and the duration of the disease.

https://www.nejm.org/doi/pdf/10.1056/NEJMra021333

The pathophysiology and treatment of sepsis.

The purpose of this article is to review the status and limitations of anatomic tumor response metrics including the World Health Organization (WHO) criteria, the Response Evaluation Criteria in Solid Tumors (RECIST), and RECIST 1.1. This article also reviews qualitative and quantitative approaches to metabolic tumor response assessment with 18 F-FDG PET and proposes a draft framework for PET Response Criteria in Solid Tumors (PERCIST), version 1.0. Methods: PubMed searches, including searches for the terms RECIST, positron, WHO, FDG, cancer (including specific types), treatment response, region of interest, and derivative references, were performed. Abstracts and articles judged most relevant to the goals of this report were reviewed with emphasis on limitations and strengths of the anatomic and PET approaches to treatment response assessment. On the basis of these data and the authors’ experience, draft criteria were formulated for PET tumor response to treatment. Results: Approximately 3,000 potentially relevant references were screened. Anatomic imaging alone using standard WHO, RECIST, and RECIST 1.1 criteria is widely applied but still has

https://jnm.snmjournals.org/content/jnumed/50/Suppl_1/122S.full.pdf

From RECIST to PERCIST: Evolving Considerations for PET Response Criteria in Solid Tumors

Prevention of Venous Thromboembolism : The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy

The detection of epithelial cells by sensitive immunological and molecular methods in blood, lymph nodes or bone marrow of gastrointestinal cancer patients may open a new approach to clinical metastasis research. The phenotypic and genomic characterization of these cells is of great value in the prediction of the further course of the disease and the monitoring of response to treatment. In addition, the role of ultrastaging in blood, lymph nodes and bone marrow of cancer patients for the indication of multimodal therapy is discussed in this review. The impact of prognostic or predictive factors for new treatment protocols in patients with gastrointestinal cancer was evaluated as well as the correlation with clinical factors.

Impact of disseminated tumor cells in gastrointestinal cancer

Das Radikalitatsausmas beim Cardiacarcinom ist Gegenstand einer kontroversen Diskussion [3]. Dabei steht der Erweiterung des Resektionsausmases in oraler Richtung — Oesophagektomie mit proximaler Magenresektion — die Radikalitatsausdehnung in aboraler Richtung — totale Gastrektomie mit distaler Oesophagusresektion — gegenuber. Die Ergebnisse dieser zwei verschiedenen Resektionsausmase wurden in einer retrospektiven Studie hinsichtlich klinischer, pathologisch-anatomischer und prognostischer Parameter miteinander verglichen.

Radikalitätsausmaß beim Cardiacarcinom — Oesophagektomie oder Gastrektomie?

http://link.springer.com/content/pdf/10.1007/BF00183969.pdf

Ist die Cholezystektomie ein Risikofaktor fr das kolorektale Karzinom?: Eine Metaanalyse

In einem 10-Jahres-Zeitraum wurden 50 Patienten mit postoperativem Rezidivulcus nach Magenresektion behandelt, von denen 31 einmal, 8 zweimal, 5 dreimal und 6 viermal am Magen voroperiert worden waren. Das Rezidivulcus lies sich in 78 % der Falle auf operationsabhangige Ursachen zuruckfuhren: zu groser Restmagen 56 %, Anastomosenstenose 18 %, Schlingenprobleme 4 %. Dagegen bestanden in 22 % der Patienten operationsunabhangige Ursachen: Abusus nichtsteroidaler Antirheumatica (NSAR) 10 %, Hyperaciditat des normal grosen Restmagens 6 %, Zollinger-Ellison-Syndrom 6 %. Als wichtigster Cofaktor der Ulcusgenese fand sich in 38 % der Gesamtgruppe ein chronischer NSAR-Abusus. Das Intervall zwischen dem Beschwerdebeginn der Ulcuskrankheit und dem letzten ulcusbedingten Eingriff betrug im Mittel 13,8 (0,5–36) Jahre. Die definitive Behandlung der Rezidivulcera war 34mal operativ – indiziert durch Ulcuskomplikationen (73,5 %) bzw. Versagen der medikamentosen Therapie (26,5 %) – und 16mal konservativ. Die Operationen umfasten 21 Nachresektionen, 7 thorakale trunculare Vagotomien, 4 Gastrektomien, 1 Operation nach Whipple und 1 Gastrinomenucleation (Operationsmortalitat 0 %). Bei einem medianen Follow-up von 7,1 Jahren, und einer Follow-up-Rate von 96 % betrug die kumulative Rerezidivulcusrate fur die konservativ behandelte Gruppe 57 % und fur die operierten Patienten 17,6 % (p < 0,05). Keiner der 8 im Langzeitverlauf verstorbenen Patienten hatte eine ulcusbedingte Todesursache.

Postoperatives Rezidivulcus nach Magenresektion – Ergebnisse der chirurgischen Behandlung

Despite the advances of en bloc esophagectomy and lymph node dissection, the results of surgical resection alone in patients with advanced squamous cell esophageal cancer remain disappointing [1, 2]. Complete macroscopic and microscopic tumor removal, i.e., an RO resection according to the UICC 1987 definition [3], provides the only chance for long-term survival in this situation [4, 5]. Due to the close anatomical relation between the esophagus, trachea, and main stem bronchi, complete macroscopic and microscopic tumor removal is particularly difficult in patients with tumors in the proximal half of the esophagus [4]. Consequently, surgical resection in patients with locally advanced squamous cell esophageal carcinoma located at or above the level of the tracheal bifurcation is usually palliative and the prognosis is dismal [4].

J. R. Siewert

Papers

Impact of disseminated tumor cells in gastrointestinal cancer

Radikalitätsausmaß beim Cardiacarcinom — Oesophagektomie oder Gastrektomie?

Ist die Cholezystektomie ein Risikofaktor fr das kolorektale Karzinom?: Eine Metaanalyse

Postoperatives Rezidivulcus nach Magenresektion – Ergebnisse der chirurgischen Behandlung

Combined Modality Treatment for Locally Advanced Squamous Cell Esophageal Carcinoma Located at or Above the Level of the Tracheal Bifurcation