Outcome for esophageal cancer following treatment with chemotherapy and radiotherapy but not esophagectomy: nonsurgical treatment of esophageal cancer

Urs Zingg1,2, Dennis DiValentino1, Alexander McQuinn1, Ahmad Mardzuki1, Sarah K Thompson2,  Christos S Karapetis1,3, David I Watson11Flinders University Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia; 2Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia; 3Department of Medical Oncology, Flinders Medical Centre, Bedford Park, South Australia, AustraliaBackground: More than 50% of patients with esophageal cancer are not suitable for surgery. The aim of this study was to analyze the outcome of patients undergoing standard nonsurgical treatment.Methods: Data of all patients undergoing nonsurgical treatment for esophageal cancer were identified from a prospective database.Results: Seventy-five patients were treated for localized disease, and 52 for metastatic disease at diagnosis. Except for age, which was higher in patients without metastases, there were no significant differences between the patients with vs. without metastatic disease. Kaplan–Meier analysis showed a median survival of 10.8 months for all patients. There was a significant difference in survival (p < 0.001) between the groups with versus without metastases, with median survival in the patients without metastases 13.6 months versus 6.5 months in patients with metastases. Patients undergoing nonsurgical treatment for localized disease had a five-year survival of 12%. No significant difference between adenocarcinoma and squamous cell carcinoma was identified. Subanalysis of patients who received chemoradiotherapy revealed similar results to the overall group of patients.Conclusion: In patients with localized disease at diagnosis, long-term survival can be achieved in some patients, whereas five-year survival is rare in patients who present with metastatic disease.Keywords: nonsurgical treatment, esophageal cancer, chemoradiotherapy, metastases, surviva

Outcome for esophageal cancer following treatment with chemotherapy and radiotherapy but not esophagectomy: Nonsurgical treatment of esophageal cancer

More than 50% of patients with esophageal cancer are not suitable for surgery. The aim of this study was to analyze the outcome of patients undergoing standard nonsurgical treatment

Revisional vs. Primary Roux-en-Y Gastric Bypass-a Case-matched analysis: Less weight loss in revisions

With the increase in bariatric procedures performed, revisional surgery is now required more frequently. Roux-en-Y gastric bypass (RYGB) is considered to be the gold standard revision procedure. However, data comparing revisional vs. primary RYGB is scarce, and no study has compared nonresectional primary and revisional RYGB in a matched control setting. Analysis of 61 revisional RYGB that were matched one to one with 61 primary RYGB was done.Matching criteria were preoperative bodymass index, age, gender, comorbidities and choice of technique (laparoscopic vs. open). After matching, the groups did not differ significantly. Previous bariatric procedures were 13 gastric bands, 36 vertical banded gastroplasties, 10 RYGB and two sleeve gastrectomies. The indication for revisional surgery was insufficient weight loss in 55 and reflux in 6. Intraoperative and surgical morbidity was not different, butmedicalmorbidity was significantly higher in revisional procedures (9.8% vs. 0%, p=0.031). Patients undergoing revisional RYGB lost less weight in the first two postoperative years compared with patients with primary RYGB (1 month, 14.9% vs. 29.7%, p=0.004; 3 months, 27.4% vs. 51.9%, p=0.002; 6 months, 39.4 vs. 70.4%, p< 0.001; 12 months, 58.5% vs. 85.9%, p<0.001; 24 months, 60.7% vs. 90.0%, p=0.003). Although revisional RYGB is safe and effective, excess weight loss after revisional RYGB is significantly less than following primary RYGB surgery. Weight loss plateaus after 12 months follow-up.Urs Zingg, Alexander McQuinn, Dennis DiValentino, Steven Kinsey-Trotman, Philip Game and David Watso