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

Adenocarcinoma of the esophagus is of special importance because it has been showing an increasing frequency, especially in Europe and North America [1]. This tumor is mostly attributed to a malignant degeneration of the columnar cell-lined lower esophagus. The results of surgical treatment of adenocarcinoma of the esophagus were prospectively analyzed and are reported in comparison to the long-term results after resection of squamous cell cancer of the esophagus, cardia cancer, and subcardial carcinomas.

Adenocarcinoma of the Esophagus: Results of Surgical Treatment

Reoperation for thyroid cancer needs to consider patient-, tumor- and therapy-related aspects as well as present diagnostic results. Reoperation because of thyroid remnants, persistence of the primary tumor and lymph node metastasis (completion surgery) has to be distinguished from reoperation due to locoregional recurrence (primary tumor, lymph nodes). The primary surgical strategy should avoid the need for reoperation. The extent of reoperation is related to the extent of primary surgery, stage, and distant metastasis. The timing and indication of reoperation for differentiated thyroid carcinoma in an interdisciplinary multimodal treatment setting depends on diagnostic radioiodine scans and radioiodine therapy. Long-term, recurrence-free survival is achieved by sufficiently radical surgery with acceptable morbidity, including all additive or adjuvant treatment options.

Reoperation for thyroid cancer

4572 Background: The treatment of cervical squamous cell carcinoma (SCC) is discussed controversial. A limited resection of the cervical esophagus and reconstruction with a free jejenunal graft int...

Cervical squamous cell carcinoma of the esophagus-a unique series of limited resection and free jejunal graft interposition after neoadjuvant RCTx in 94 patients

SummaryDespite the continuing incidence and prevalence of adenocarcinoma of the proximal gastric third and esophago-gastric junction, the classification and optimal therapy of these tumors remains controversial. From the anatomic, pathologic and therapeutic point of view a discrimination of these tumors into those of the gastric fundus, subcardial gastric carcinoma (or adenocarcinoma of the esophago-gastric junction type III according to Siewert, AEG type III), true carcinoma of the gastric cardia (AEG type II) and adenocarcinoma of the distal esophagus (AEG type I) appears logical. A special aspect of tumors of the proximal gastric third is their lymphatic drainage towards the splenic hilum and the left para-aortic lymph nodes. In addition, the proximal gastric third is characterized by a rather large proportion without serosal covering in the area of the major and lesser gastric curvature. Consequently, transmural tumors at this location are frequently assigned the T2 category according to the current UICC criteria, although the true depth of wall penetration and prognosis correspond to that of a more advanced T category.The surgical therapy of choice for tumors of the gastric fundus as well as for subcardial gastric cancers (AEG type III) and true carcinomas of the gastric cardia (AEG type II) is an extended total gastrectomy with resection of the distal esophagus. The optimal extent of lymphadenectomy in these patients includes, at least theoretically, the lymph nodes along the splenic artery, the splenic hilum and the para-aortic lymph nodes at the left renal hilum in addition to the so-called compartments I and II. Since a left pancreatic resection is associated with significant morbidity, a pancreas-preserving splenectomy (PPS) should be performed to complete the lymphadenectomy in the retroperitoneum. The markedly worse prognosis of proximal-third gastric cancer, as compared to more distally located gastric tumors, is due to the current UICC classification which does not take into account the special location and lymphatic drainage of these tumors. A modification of the UICC classification for these tumors appears reasonable. Copyright © 1999 S. Karger GmbH, Freiburg

J. R. Siewert

Papers

Adenocarcinoma of the Esophagus: Results of Surgical Treatment

Reoperation for thyroid cancer

Cervical squamous cell carcinoma of the esophagus-a unique series of limited resection and free jejunal graft interposition after neoadjuvant RCTx in 94 patients

Chirurgische Therapie bei Karzinomen des proximalen Magendrittels und des ösophagogastralen Übergangs

[Lymphadenectomy - a matter of faith?].