The role of neoadjuvant and adjuvant treatment for adenocarcinoma of the upper gastrointestinal tract

Both locally advanced adenocarcinoma of the stomach and gastro-esophageal junction are associated with poor prognosis due to the lack of effective treatment. Recently multimodal treatment consisting of neoadjuvant chemotherapy in combination with radiotherapy is reported to improve survival when compared to surgery alone. Neoadjuvant therapy in these locally advanced tumors allows for early tumor responses and the extent of tumor regression that can be achieved is considered a significant prognostic factor. This, in turn, increases the resectability of these tumors. Also due to the high frequency of lymph node metastasis, patients with locally advanced adenocarcinoma should undergo a D2 lymphadenectomy. Postoperative chemoradiation and perioperative chemotherapy have been studied in gastric adenocarcinomas and showed a survival benefit. However, the surgical techniques used in these trials are no longer considered to be standard by today's surgical practice. In addition, there are no standard recommendations for adjuvant chemotherapy or chemoradiation after R0 resection and adequate lymph node dissection

Liver resection and ablation for squamous cell carcinoma liver metastases.

Funder: Region StockholmFunder: Region Stockholm (clinical postdoctoral appointment)BACKGROUND: Limited evidence exists to guide the management of patients with liver metastases from squamous cell carcinoma (SCC). The aim of this retrospective multicentre cohort study was to describe patterns of disease recurrence after liver resection/ablation for SCC liver metastases and factors associated with recurrence-free survival (RFS) and overall survival (OS). METHOD: Members of the European-African Hepato-Pancreato-Biliary Association were invited to include all consecutive patients undergoing liver resection/ablation for SCC liver metastases between 2002 and 2019. Patient, tumour and perioperative characteristics were analysed with regard to RFS and OS. RESULTS: Among the 102 patients included from 24 European centres, 56 patients had anal cancer, and 46 patients had SCC from other origin. RFS in patients with anal cancer and non-anal cancer was 16 and 9 months, respectively (P = 0.134). A positive resection margin significantly influenced RFS for both anal cancer and non-anal cancer liver metastases (hazard ratio 6.82, 95 per cent c.i. 2.40 to 19.35, for the entire cohort). Median survival duration and 5-year OS rate among patients with anal cancer and non-anal cancer were 50 months and 45 per cent and 21 months and 25 per cent, respectively. For the entire cohort, only non-radical resection was associated with worse overall survival (hazard ratio 3.21, 95 per cent c.i. 1.24 to 8.30). CONCLUSION: Liver resection/ablation of liver metastases from SCC can result in long-term survival. Survival was superior in treated patients with liver metastases from anal versus non-anal cancer. A negative resection margin is paramount for acceptable outcome

Status quo of plastic-reconstructive surgery from the perspective of a general and visceral surgeon

The Art of Surgery has a very long tradition and is one of the earliest treatments for serious injuries of diverse causes. Due to achievements in anesthesia and intensive care medicine in the second half of the nineteenth century, postoperative morbidity and mortality have been appreciably reduced. Operative techniques could be expanded and new operative therapies could be introduced. Although the last two-hundred years have brought about increasing specialization in medicine and operative specialties have developed in multiple areas, the operative spectrum of the visceral surgeon has remained rather broad and diverse. Numerous operative procedures are carried out in the entire gastrointestinal tract as well as the body surface. Many of these are to treat diseases, while others are of help in the plastic reconstruction of organs and the body surface. Thanks to specialization, among the positive developments are shortened operation time and length of hospital stay, as well as reduced postoperative morbidity and mortality. The advances in minimal-invasive surgery and the progress in surgical instruments and suturing techniques are some origins of these positive developments. This article cannot cover all possible resections and reconstructions of the visceral surgeon, but will instead concentrate on two major sites. The operative treatment of inguinal hernias is one of the oldest operations known to humanity. Because hernias are one of the most common operations of all visceral surgical procedures, their surgical therapy shall be particularly highlighted here. But the plastic and reconstructive possibilities of the visceral surgeon are by no means limited to hernia repair. So this manuscript will further provide insight into the resection and reconstruction possibilities of the esophagus, one of the most challenging procedures in this field