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.)

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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

Durch das Tumordebulking gastrointestinaler Tumoren soll eine Tumormassenreduktion zur Erhohung der Wirksamkeit nachfolgender Therapiemodalitaten, erfolgen. Bei diesen fortgeschrittenen Carcinomleiden ist eine solche Therapieform mit einer erhohten Morbiditat und Letalitat verbunden. Adjuvante Therapien gelangen fristgerecht nicht zur Anwendung. Ein Langzeituberleben kann dadurch nicht verbessert werden. Fortschritte der biomedizinischen Grundlagenforschung vermogen erste Erklarungsversuche fur dieses Therapieversagen zu geben. Auf ihnen basieren neuere Behandlungskonzepte wie das der neoadjuvanten Therapie lokal fortgeschrittener Tumoren. Die Rate, der zur Verbesserung des Langzeituberlebens notwendigen R0-Resektion, kann dadurch moglicherweise verbessert werden. Erste prospektive, neoadjuvante Studien gastrointestinaler Neoplasien, sind bereits sehr ermutigend.

Bedeutung des Tumordebulkings bei gastrointestinalen Tumoren

In general, lymphadenectomy is indicated as a surgical treatment of esophageal carcinoma. It is also proven that lymphadenectomy is necessary for precise tumor staging. Adjuvant and additive therapy a

Lymphadenectomy in Esophageal Cancer Surgery

Spontaneous rupture of major vessels is a known though rare complication in treatment of patients with esophageal cancer, but its pathophysiology is not very well understood. We herein report about the sudden death of a 42-year-old man due to spontaneous aortic rupture, 11 days after transthoracic esophagectomy. Because of a locally advanced squamous cell carcinoma of the distal esophagus, which was considered irresectable at the time of presentation, the patient had received one course of chemotherapy followed by synchronous chemoradiation (60 Gy, 5-fluorouracil and cisplatin) prior to surgery. We discuss the patho-anatomic findings of the postmortem examination concerning alterations of the aortic wall and the potential correlations with aggressive radiochemotherapy protocols.

Delayed aortic rupture after radiochemotherapy and esophagectomy for esophageal cancer

Grundlagen: Die sogenannte erweiterte diagnostische Laparoskopie (EDL) ist ein minimal-invasiver chirurgischer Eingriff, der die Exploration des gesamten Bauchraumes ermoglicht und somit das pratherapeutische Staging bei malignen Erkrankungen erheblich verbessern kann.

Erweiterte Diagnostische Laparoskopie (EDL)

Osophagusdivertikel werden in Pulsionsdivertikel und Traktionsdivertikel unterteilt. Den Hauptanteil der Pulsionsdivertikel bilden die Zenker-Divertikel oder Hypopharynxdivertikel. Symptomatische Zenkerdivertikel stellen eine absolute Operationsindikation dar. Bestandteil der Operation ist die Myotomie des oberen Osophagussphinkters mit oder ohne begleitende Divertikelabtragung. Als Alternative zur konventionellen, offenen Operation hat sich bei groseren Divertikeln auch die transorale Schwellenspaltung etabliert. Fur die Behandlung des epiphrenischen Divertikels (Pulsionsdivertikel) spielt die Therapie der zugrunde liegenden Motilitatsstorung die entscheidende Rolle fur das operative Vorgehen. Typische Traktionsdivertikel sind die parabronchialen Divertikel. Eine Operationsindikation ist hier nur in Ausnahmefallen gegeben. Unabhangig von ihrer Lokalisation und Genese liegt die Erfolgsrate der chirurgischen Therapie der Osophagusdivertikel bei adaquater Indikationsstellung bei uber 90%.

J. R. Siewert

Papers

Bedeutung des Tumordebulkings bei gastrointestinalen Tumoren

Lymphadenectomy in Esophageal Cancer Surgery

Delayed aortic rupture after radiochemotherapy and esophagectomy for esophageal cancer

Erweiterte Diagnostische Laparoskopie (EDL)

Therapy of esophageal diverticula