Cardioesophageal Cancer Research Articles

Risk of Second Primary Cancer Among Patients with Cardio-Esophageal Cancer in Finland: A Nationwide Population-Based Study.

The occurrence of a second primary cancer (SPC) after primary esophageal carcinoma (EC) or gastric cardia carcinoma(GCC) is well acknowledged. However, previous research on the risk of SPC among these patients has been predominantly conducted in Asian countries. Yet, notable population-dependent variation in histological types and risk profiles exists. This register-based study assesses the histology-specific risk of SPC among individuals initially diagnosed with a first primary EC or GCC. We obtained data on 7197 patients diagnosed with EC/GCC in Finland between 1980 and 2022 from the Finnish Cancer Registry. Standardized incidence ratios (SIR) of SPC were subsequently calculated relatively to the cancer risk of the general population. The average and median follow-up times were 2.8 years and 10.5 months. Adenocarcinomas and squamous cell carcinomas comprised 57.8% (n = 4165) and 36.6% (n = 2631) of all cases, respectively. An increased SIR was noted among EC/GCC patients after 15-20 years of follow-up (SIR 1.49, 95% CI: 1.01-2.11). Among adenocarcinoma patients, an increased SIR for SPCs of the digestive organs was seen in the 40-54-year-old group (SIR 9.86, 95% CI: 3.62-21.45). Squamous cell carcinoma patients displayed increased SIRs for cancer of the mouth/pharynx (SIR 3.20, 95% CI: 1.17-6.95) and respiratory organs (1.77, 1.07-2.76). Healthcare professionals should be aware of the increased risk of SPCs occurring in the mouth/pharynx, respiratory and digestive organs in survivors of EC/GCC. Patients should be advised about this risk and remain alert for symptoms, even beyond the standard 5-year follow-up period.

Primary adenocarcinoma of antral part of gastric transplant after radical operation for cardioesophageal cancer

Первинна аденокарцинома антрального відділу шлункового трансплантата після радикальної операції з приводу кардіоезофагеального раку

Endoscopic diagnosis and treatment of patient with early cardioesophageal cancer three months after gastric bypass surgery

Problems of obesity and its accompanying metabolic disorders remain relevant throughout the world and are due to an increased risk of disability and early mortality in patients with this pathology. Currently, bariatric surgery is recognized as the most effective treatment for morbid obesity. Of exceptional importance are not only the technical features of operation, but also a full preoperative examination. The occurrence of gastric cancer after bariatric surgery is a rare but occurring phenomenon, often associated with insufficient quality of preoperative endoscopic examination. We presented a clinical case of endoscopic diagnosis and removal of early cardioesophageal cancer in a patient with morbid obesity, three months after mini-gastric bypass surgery, as well as examine bypassed stomach with single- balloon enteroscope.

Lymph node dissection in the surgical treatment of cancer of the esophagus and cardioesophageal region

The results of lymphadenectomy in esophagus resection and cardioesophageal cancer are studied. During the period from 1990 to 1998 112 patients were operated because of the cancer of esophagus and cardial part of the stomach. Metastases were found in less than half of the patients with increased the lymphnodes during the operation. In some cases metastases were found in the absence of their visible increase. It is concluded that the esophagus resection because of the cancer with one moment esophagoplasty should be accompanied by lymphadenectomy from regional lymphatic collectors. The adequate determination of the esophagus cancer, resectability, optimal choice of approach and methods of operation supplied by enlarged lymphadenectomy gave the encouraging results.

ЭПИДЕМИОЛОГИЧЕСКИЕ ТЕНДЕНЦИИ КАРДИОЭЗОФАГЕАЛЬНОГО РАКА ЖЕЛУДКА И РАКА ПИЩЕВОДА В РЕСПУБЛИКЕ ХАКАСИЯ

Aim to analysis of the epidemiological characteristics of gastric cancer of proximal localization and esophagus cancer in the population of the Republic of Khakassia. Materials and methods. We studied 142 cases of esophagus cancer and 684 cases of gastric cancer, including 74 incidents of proximal localization by the continuous method for 2015-2019 (100%). In all cases, the diagnosis was established according to ICD 10 revision, TNM (2009) and verified morphologically. The study of the clinical debut of malignant tumors was carried out by comparing the general popula- tions of patients with esophagus cancer and gastric cancer of proximal localization over a 5-year period, dividing for 10-year-period groups. Results. There is an increase in the incidence rate of cancer of the esophagus by 1.4 times, gastric cancer by 1.1 times, and the share of cardioesophageal cancer of the stomach to 17.6%. Squamous cell car- cinoma dominates in the morphological structure in case of cancer of the esophagus (86, 6%), and adenocarcinoma (96.2%) in case of gastric cancer. Men have 1.26 times more often with gastric cancer of all localizations than women, 1.64 times more with cardioesophageal cancer of the stomach, 4.9 times more in patients with cancer of the esopha- gus, consistently. An exception are tumors of the bottom of the stomach (men are 0.75 times less than women). In cancer of the esophagus, the most frequent manifestation age is 60-69 years (42.9%). With cardioesophageal cancer of the stomach, every second patient is over 70 years old. Conclusion. The incidence of cardioesophageal cancer of the stomach and cancer of the esophagus is increasing.

Possibilities of endoscopy in diagnosis and treatment of patients with early cardioesophageal cancer

<h3></h3> Вопросы диагностики и лечения ранних форм рака пищеводно-желудочного перехода до сих пор остаются предметом дискуссий онкологов, хирургов, эндоскопистов и морфологов. Расположение опухоли относительно Z-линии, гистологическое строение и степень дифференцировки опухоли, размеры и макроскопический тип, глубина инвазии в стенку — основные факторы, влияющие на выбор тактики лечения и прогноз заболевания. В настоящей статье представлен краткий обзор, включающий понятие, классификацию, эпидемиологию и патоморфологию кардиоэзофагеального рака. По аналогии с ранним раком желудка рассмотрено понятие «ранний кардиоэзофагеальный рак», описаны возможности эндоскопической диагностики и лечения пациентов с такой патологией.

Correlation of SOX-2 and NOTCH1 copy numbers with vimentin expression in orthotopic patient-derived xenografts of cardioesophageal cancer in immunodeficient mice.

e15034 Background: Cardioesophageal cancer is one of the most common tumors affecting the mucosa of the cardiac stomach and distal esophagus. Despite the variety of treatment strategies and chemotherapy agents, the prognosis for the patients remains poor. The purpose of the study was to analyze the relative copy numbers of SOX-2 and NOTCH1 and vimentin expression in orthotopic patient-derived xenografts of cardioesophageal cancer. Methods: The model of cardioesophageal cancer was created in Balb/c Nude mice with surgical bioptates of moderately differentiated adenocarcinoma obtained from a donor with infiltrative ulcerative cancer of the lower third of the esophagus with a transition to the cardiac stomach into the distal esophagus of Balb/c Nude mice. The index of proliferative activity in the bioptates was assessed by IHC. The relative copy numbers of SOX-2 and NOTCH1 and vimentin expression were determined by Real-Time qPCR. Results: Expression of vimentin was absent in tissues of the donor tumor. The levels of vimentin expression statistically significantly increased in xenografts (1+ and 3+). The SOX-2 and NOTCH1 relative copy numbers were statistically significantly increased in tissues of the donor tumor (0.9 and 0.7), compared to xenografts (1.5±0.03 and 1.7±0.03). Molecular genetic analysis demonstrated an association between an increased vimentin expression and changes in the relative copy numbers of SOX-2 and NOTCH1 (p = 0.013 and p = 0.0001). Conclusions: The relative copy numbers of SOX-2 and NOTCH1 genetic loci was associated with increased expression of the epithelial-mesenchymal transition marker vimentin in tumor tissue samples and changed with each new generation of orthotopic xenografts.

Analysis of the relative copy numbers of TP63, YAP1 and KMT2D genetic loci and EGFR expression in orthotopic patient-derived xenografts of cardioesophageal cancer in immunodeficient mice.

e15033 Background: Cardioesophageal cancer is a common tumor affecting the cardiac stomach and lower esophagus. Tumor heterogeneity is important, since it can cause the ineffectiveness of chemotherapy and radiotherapy due to individual characteristics of the neoplasm in different patients, as well as the intensification of invasion and metastasis. Our purpose was to analyze the relative copy numbers of TP63, YAP1 and KMT2D genetic loci and EGFR expression in orthotopic patient-derived xenografts of cardioesophageal cancer. Methods: The model of cardioesophageal cancer was created in Balb/c Nude mice with surgical bioptates of adenocarcinoma obtained from donors. The relative copy numbers of TP63, YAP1 and KMT2D genetic loci and EGFR expression were determined by Real-Time qPCR. Results: A PDX model of cardioesophageal cancer was successfully created by transplanting a moderately differentiated adenocarcinoma from a patient diagnosed with infiltrative ulcerative cancer of the lower third of the esophagus with a transition to the cardiac stomach into the distal esophagus of Balb/c Nude mice. The EGFR expression was elevated in patient tumor samples, compared to healthy tissues (p = 0.021) and gastric cancer xenografts (p = 0.07). Molecular genetic analysis demonstrated an association between an increased EGFR expression and changes in the relative copy numbers of TP63, YAP1, and KMT2D in donor samples compared to gastric cancer xenografts (p = 0.02, p = 0.026 and p = 0.042). Conclusions: The relative copy numbers of TP63, YAP1, and KMT2D were associated with intensified EGFR expression and changed with each new generation of orthotopic xenografts.

New Approach to the Surgical Treatment of Cardioesophageal Cancer in the Context of the COVID-19 Pandemic (Case Report)

Background. The wide and rapid spread of the new coronavirus infection, unfortunately, makes its own adjustments in clinical practice, including in the promotion of specialized care for oncological patients. Clinical case description. The authors demonstrated an example of a successful radical treatment of adenocarcinoma of the esophageal-gastric junction, complicated by dysphagia and recurrent bleeding from the tumor. Аn integrated approach, gastrostomy, adequate correction of concomitant diseases and timely vaccination against COVID-19 made it possible to carry out a full-fledged intervention in a timely manner. Conclusions. Radical treatment of patients with gastrointestinal toncological diseases in a severe viral pandemic is possible. Emergency vaccination significantly reduces the risk of developing severe respiratory and other disorders.

196 – Totally Robotic Ivor-Lewis Esophagectomy with Intrathoracic Robot-Sewn Anastomosis for Cardioesophageal Cancer with the Da Vinci Xi

196 – Totally Robotic Ivor-Lewis Esophagectomy with Intrathoracic Robot-Sewn Anastomosis for Cardioesophageal Cancer with the Da Vinci Xi

Short-term outcomes of surgical treatment of gastroesophageal junction cancer

To confirm simplicity, safety and efficacy of stapling devices for gastroesophageal anastomosis (including those formed in mediastinum) in the treatment of gastroesophageal junction cancer. There were 147 patients with cardioesophageal cancer. Tumors Siewert type II and III were predominant (44.2 and 40.3%, respectively). Simultaneous procedures were performed in 30.6% of cases. Postoperative complication rate was 42.2%. Pneumonia was the most common. Postoperative mortality was 2.7%.

Minimally invasive surgery for cardioesophageal cancer

Minimally invasive surgery for cardioesophageal cancer

Quality of life of patients with cancer of the esophagus and cardioesophageal cancer

The urgency of the study is due to the aggressiveness of esophageal cancer and cardioesophageal cancer, low survival rate of patients, the need for further development aimed at improving the consequences of surgical intervention, the effectiveness of which can be evaluated with the help of determining the quality of life of these patients. The aim of the work is to assess the quality of life of patients with esophagus cancer and cardioesophageal cancer after radical surgery, depending on the variant of the formed esophagogastroanastomosis based on the analysis of indicators of the general condition of patients and the severity of esophageal-gastric symptoms at different stages of observation. 60 patients with cancer of the esophagus and cardioesophageal cancer after proximal gastrectomy with resection of the esophagus accesses of Lewis or Osawa Garlock were subject to questioning. The patients were divided into two groups: the study group consisted of 30 patients who had developed the mechanical invagination of the esophagogastro-anastomosis developed and protected by the Ukrainian patent, the comparison group made up 30 patients who had the end-to-side mechanical esophagogastroanastomosis formed. Quality of life was assessed before surgery and at 3, 6, and 12 months after surgery. The EORTC QLQ-C30 V.3 questionnaire was used to assess the general condition of the patients, and the EORTC QLQ-OG25 questionnaire was used to assess the presence of specific gastrointestinal symptoms. Statistical analyses were performed using EZR v.1.35 software (Saitama Medical Center, Jichi Medical University, Saitama, Japan, 2017), which is a graphical user interface for R (The R Foundation for Statistical Computing, Vienna, Austria). To analyze the dynamics of the indicators, the Friedman criterion was used for repeated measurements, pairwise comparisons were performed according to the Conover criterion. To verify the validity of the differences between dependent samples, the non-parametric W-criterion of Wilcoxon was used. It was established that the general condition of the patients after surgery, assessed by the EORTC QLQ-C30 V.3 scales, did not depend on the method of formation of esophagogastroanastomosis. The results of the study of the quality of life of patients after surgery with various ways of forming esophagogastroanastomosis modulo EORTC QLQ-OG25 showed significantly lower frequency rate of symptoms such as reflux, pain and discomfort in the stomach, nutritional problems in front of other people and a sense of physical unattractiveness in the group of patients for which formation of a mechanical invagination esophagogastroanastomosis was applied.

Results of the Endoscopic Stenting in Palliative Treatment of Cardioesophageal Cancer

he article describes experience of treating 232 patients with unresectable cardioesophageal cancer. Of these, minimally invasive endoscopic procedures: endoscopic diatermotunnelization, endoscopic bougienage and endoscopic stenting was performed in 101 patients. Currently, the method of endoscopic stenting is preferred, which was performed in 84 patients, own-developed model of a silicone tube stent was used in all patients. Main early and late complications of using this method were described.Key words: Тumours of the proximal part of the stomach, of surgical treatment, un-resectability, of minimally invasive technologies, diathermotunnelization, endoscopic bougienage and endoscopic stenting

COMPUTED TOMOGRAPHY POTENTIALS IN THE DIAGNOSIS OF HIATAL HERNIA

Hiatal hernias comprise approximately 90% of all diaphragmatic hernias, occur in about 5% of the adult population, may be asymptomatic or accompanied by various clinical manifestations. An important complication is edema of the mucosa which surrounds cardia. It is edema of the mucosa which can cause dysphagia and other clinical manifestations that require special anti-inflammatory treatment. Computed tomography is usually performed for suspected diseases of the chest or abdomen and the area of cardioesophageal junction is neglected. In our work the special technique of computer tomography is presented which allows the detailed examination of this anatomical region, depiction of unaltered cardia and adjacent anatomical structures, detection of the semiotics of different variations of hiatal hernias. The possibilities of CT-imaging in the detection of complications of this pathologic condition and the combination with cardioesophageal cancer are described.

Role of ultrasound and spiral computed tomography in diagnosis of cardioesophageal cancer

Аim. The incidence of cardioesophageal cancer has been steadily increasing over the past few decades, posing significant diagnostic challenges. Materials and metods . X-ray examination remains the primary imaging modality for the initial diagnosis of gastric tumors. However, the modern imaging techniques, such as ultrasound (US) and spiral computed tomography (SCT) are needed to assess the extent of tumor invasion into the gastric wall and adjacent organs as well as lymph node involvement and metastatic spread. Conclusion. The role of US and SCT in diagnostic imaging of cardioesophageal cancer was studied and the examination algorithm using US and SCT with conventional X-rays was offered.

Resection of the proximal part of the stomach and thoracic esophagus for cardioesophageal cancer through combined laparo-thoracoscopic approach. Several points and short-term results

Resection of the proximal part of the stomach and thoracic esophagus for cardioesophageal cancer through combined laparo-thoracoscopic approach. Several points and short-term results

The peculiarities of stenting in the patients with cardioesophageal cancer

Заболеваемость злокачественными новообразованиями пищевода и пищеводно-желудочного перехода неуклонно увеличивается. На момент обращения большинство пациентов являются инкурабельными из-за распространенности опухолевого процесса или тяжелой сопутствующей патологии. В случаях нерезектабельности опухоли нарастание степени выраженности дисфагии практически неизбежно. Современные малоинвазивные технологии оптимальны для симптоматического лечения больных с неоперабельным раком пищевода. Стентирование пищевода — наименее травматичное и эффективное вмешательство, значительно улучшающее качество жизни пациентов и дающее хороший лечебный эффект, тем самым в большей степени сохраняющее их психологическое здоровье. Установка стента в зону пищеводно-желудочного перехода имеет некоторые дополнительные особенности и несет в себе более высокий риск развития осложнений по сравнению со стентированием проксимальных отделов пищевода. Подбор стента при локализации опухоли в зоне кардии имеет решающее значение для предотвращения таких осложнений, как миграция и патологический гастроэзофагеальный рефлюкс. Ключевые слова: кардиоэзофагеальный рак, дисфагия, стентирование, миграция стента. There is an increasingly growing trend in morbidity associated with malignant neoplasms of the oesophagus and the gastroesophageal junction. The majority of the patients with this condition apply for medical aid when the disease is already incurable due to the widespread malignant process or severe concomitant pathology. The presence of the non-resectable tumour inevitably leads to aggravation of dysphagia. The modern minimally invasive technologies provide the optimal opportunity for the symptomatic treatment of the patients presenting with inoperable cancer of oesophagus. Oesophageal stenting is a minimally invasive and highly efficacious intervention allowing to significantly improve the patients' quality of life and ensuring good therapeutic effect that greatly promotes their psychic health. The placement of the stent in the gastroesophageal junction requires certain additional precautions and creates a greater risk of complications compared with stenting of the proximal segments of the oesophagus. The correct choice of the stents for the patients having the tumour localized in the gastric cardia is of paramount importance for the prevention of such complications as migration of the stent and pathological gastroesophageal reflux.

Stenting during cardio-esophageal cancer recurrence in the area of esophago-intestinal anastomosis after gastroectomy

The purpose of the study - the restoration of patency during recurrent stenosing esophageal cancer. 69 years old patients with relapsed cardio-esophageal cancer, accompanied by stenosis of the anastomosis were examined. Successfully performed balloon dilatation, stenting self-expanding stent Hanarostent HEV-18-90-070, restored the possibility of enteral nutrition. Stenting for recurrent cancer can be recommended as an alternative to re-operation.

Cardioesophageal Cancer: Best Treatment Strategies

Objective: We examined the clinicomorphologic factors associated with the low- and high-risk of generaliza- tion of cardioesophageal cancer (CEC) (T1-4N0-2M0) after complete (R0) esophagogastrectomies (EG) through left tho- racoabdominal incision. Methods: We analyzed data of 175 consecutive CEC patients (CECP) (age = 55.3 ± 8.7 years; tumor size = 6.9 ± 3.3 cm) radically operated and monitored in 1975-2008 (males = 132, females = 43; combined EG with resection of pancreas, liver, diaphragm, colon transversum, lung, trachea, pericardium, splenectomy - 71; lymphadenectomy D2 - 98, D3-D4 - 77; esophagogastroanastomosis - 98, esophagoenteroanastomosis - 77; adenocarcinoma - 112, squamous cell carcinoma - 58, mix - 5; T1 - 24, T2 - 38, T3 - 66, T4 - 47; N0 - 70, N1 - 22, N2 - 83; G1 - 52, G2 - 34, G3 - 89; surgery alone - 128; surgery and adjuvant chemoimmunotherapy-AT: 5FU + thymalin/taktivin, 5-6 cycles - 47 CECP). Variables selected for 5-year survival (5YS) study were input levels of 45 blood parameters, sex, age, TNMPG, cell type, tumor size. Survival curves were estimated by the Kaplan-Meier method. Differences in curves between groups of CECP were evaluated using a log-rank test. Multivariate Cox modeling, multi-factor clustering, structural equation modeling, Monte Carlo, bootstrap simulation and neural networks computing were used to determine any significant dependence. Results: For total of 175 CECP overall life span (LS) was 1381.6 ± 1486.7 days, (median - 723 days) and cumulative 5YS reached 36.1%, 10 years - 26.6%. 53 CECP lived more than 5 years without CEC progressing. 104 CECP died because of CEC during the first 5 years after surgery. 5YS of CECP was superior significantly after AT (69.9%) compared with sur- gery alone (26.6%) (P = 0.000 by log-rank test). Cox modeling displayed that 5YS of CECP (n = 175) after complete EG significantly depended on: phase transition (PT) early-invasive CEC, PT N0-N12, AT, age, T, tumor growth, Rh-factor, blood cell subpopulations, cell ratio factors (P = 0.000-0.047). Neural networks computing, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and early-invasive CEC (rank = 1), PT N0-N12 (rank = 2), AT (rank = 3), T (4), gender (5), prothrombin index (6), weight (7), glucose (8), age (9), coagulation time (10), eosino- phils/cancer cells (11), erythrocytes/cancer cells (12), hemorrhage time (13), protein (14), Hb (15), segmented neutro- phils/cancer cells (16), stab neutrophils/cancer cells (17). Correct prediction of 5YS was 100% by neural networks com- puting (error = 0.0009e-12; urea under ROC curve = 1.0).