Staging Of Gastrointestinal Cancers Research Articles

Standardized diagnosis of gastrointestinal tumors: an update regarding the situation in Germany.

To evaluate the current status of the diagnosis of gastrointestinal tumors in Germany by means of a survey of the oncological imaging working group of the German Radiological Society (DRG) with a focus on the CT protocols being used.Radiologists working in outpatient or inpatient care in Germany were invited. The survey was conducted between 10/2022 and 06/2023 using the SurveyMonkey web tool. Questions related to gastrointestinal cancer were asked with regard to the commonly used imaging modalities, body coverage, and contrast agent phases in CT as well as the use of oral or rectal contrast. The results of the survey were analyzed using descriptive statistics.Clear differences were identified regarding the acquired contrast phases in relation to the place of work - outpatient care, smaller hospitals, maximum care hospitals, or university hospitals. Variances were also recognized regarding oral and rectal contrast. Based on the results and international guidelines, proposals for CT protocols were derived.CT protocols in Germany show a heterogeneous picture regarding acquired contrast phases, as well as oral and rectal contrast for the staging of gastrointestinal cancer. Clear recommendations in the respective guidelines would aid in quality assurance and comparability between different centers. · The examination protocols for the staging of gastrointestinal tumors are heterogeneous in Germany.. · The application of oral and rectal contrast is handled differently at the various radiological centers.. · Standardization of imaging should be targeted.. · Gerwing M, Ristow I, Afat S et al. Standardized diagnosis of gastrointestinal tumors: an update regarding the situation in Germany. Fortschr Röntgenstr 2024; DOI 10.1055/a-2378-6451.

A survey on multi-omics-based cancer diagnosis using machine learning with the potential application in gastrointestinal cancer.

Gastrointestinal cancer is becoming increasingly common, which leads to over 3 million deaths every year. No typical symptoms appear in the early stage of gastrointestinal cancer, posing a significant challenge in the diagnosis and treatment of patients with gastrointestinal cancer. Many patients are in the middle and late stages of gastrointestinal cancer when they feel uncomfortable, unfortunately, most of them will die of gastrointestinal cancer. Recently, various artificial intelligence techniques like machine learning based on multi-omics have been presented for cancer diagnosis and treatment in the era of precision medicine. This paper provides a survey on multi-omics-based cancer diagnosis using machine learning with potential application in gastrointestinal cancer. Particularly, we make a comprehensive summary and analysis from the perspective of multi-omics datasets, task types, and multi-omics-based integration methods. Furthermore, this paper points out the remaining challenges of multi-omics-based cancer diagnosis using machine learning and discusses future topics.

Gastrointestinal Cancer Stage at Diagnosis Before and During the COVID-19 Pandemic in Japan

The COVID-19 pandemic has delayed medical consultations, possibly leading to the diagnosis of gastrointestinal cancer at advanced stages. To evaluate stage at diagnosis among patients with gastrointestinal cancer in Japan before and during the COVID-19 pandemic. This retrospective cohort study included patients in a hospital-based cancer registry who were diagnosed with gastrointestinal cancer (ie, esophageal, gastric, colorectal, pancreatic, liver, and biliary tract cancers) between January 2016 and December 2020 at 2 tertiary Japanese hospitals. The pre-COVID-19 period was defined as January 2017 to February 2020, and the COVID-19 period was defined as March 2020 to December 2020. Monthly numbers of patients with newly diagnosed cancer were aggregated, classified by stage, and compared. The study evaluated 5167 patients, including 4218 patients (2825 [67.0%] men; mean [SD] age, 71.3 [10.9] years) in the pre-COVID-19 period and 949 patients (607 [64.0%] men; mean [SD] age, 71.8 [10.7] years) in the COVID-19 period. Comparing the pre-COVID-19 period with the COVID-19 period, significant decreases were observed in the mean (SD) number of patients with newly diagnosed gastric cancer (30.63 [6.62] patients/month vs 22.40 [5.85] patients/month; -26.87% change; P < .001) and colorectal cancer (41.61 [6.81] patients/month vs 36.00 [6.72] patients/month; -13.47% change; P = .03). Significant decreases were also observed in the mean (SD) number of cases of stage I gastric cancer (21.55 [5.66] cases/month vs 13.90 [5.99] cases/month; -35.51% change; P < .001), stage 0 colorectal cancer (10.58 [3.36] cases/month vs 7.10 [4.10] cases/month; -32.89% change; P = .008), and stage I colorectal cancer (10.16 [3.14] cases/month vs 6.70 [2.91] cases/month; -34.04% change; P = .003). No significant increases were observed for esophageal, gastric, pancreatic, liver, or biliary tract cancers. A significant decrease was observed in the mean (SD) number of cases per month of stage II colorectal cancer (7.42 [3.06] cases/month vs 4.80 [1.75] cases/month; -35.32% change; P = .01); a significant increase was observed for the mean (SD) number of cases per month of stage III colorectal cancer (7.18 [2.85] cases/month vs 12.10 [2.42] cases/month; 68.42% change; P < .001). In this cohort study of patients in a hospital-based cancer registry form Japan, significantly fewer patients were diagnosed with stage I gastric and colorectal cancers during the COVID-19 pandemic. Thus, the number of screening-detected cancers might have decreased, and colorectal cancer may have been diagnosed at more advanced stages.

APPLICATION OF GLACIAL ACETIC ACID, ETHANOL, WATER AND FORMALIN (GEWF) SOLUTION FOR LYMPH NODE RETRIEVAL FOLLOWING LAPAROSCOPIC GASTRECTOMY AND LAPAROSCOPIC COLECTOMY FOR CANCER

The number of lymph node retrieval is an important factor in the staging of gastrointestinal cancers, especially gastric and colorectal neoplasm. The concept that at least 12 lymph nodes for colorectal cancer and 15 lymph nodes for gastric cancer should be evaluated as a quality measure. To increase the number of lymph node harvesting, besides the correct implementation of surgical principles and systematic lymphadenectomy, the retrieval of lymph nodes from the patient’s specimen is also a significant issue. There are many methods to support lymph node revealing more convenient than harvesting on fresh specimens. Here we report the application of Formol-Alcohol-Acetic Acid solution in evaluating the possibility of lymph node harvesting after laparoscopic gastrectomy and colectomy for cancer. The number of lymph nodes found was a significant increase, with 88 in the colon and 40 in the gastric specimen. Key words: Lymph node retrieval, GEWF, Formol-Alcohol-Acetic Acid, gastric cancer, colon cancer

Evaluating Influence of Seamless Nursing for the Gastrointestinal Cancer Patients

Objective: to evaluate effect of seamless nursing for complications on gastrointestinal cancer patients. Methods: 266 patients diagnosed as gastrointestinal cancer from June 2016 to March 2019. The control group and intervention group were assigned from participants after they agreed to join this study. We collected the information by different questionnaires and hospital record, the questionnaires included Self-Rating Anxiety Scale (SAS), the Self-rating depression scale (SDS) and Self-rating form of satisfaction. Result: The most of gastrointestinal cancer stage in two groups was early gastrointestinal cancer [57 (42.9%) & 55 (41.4%), p=0.023]. In SAS and SDS research, the improvement was not significant (34.22±1.12 vs 46.32±3.26, 32.38±3.01 vs 46.52±5.84), the improvement had statistical significance. In satisfaction research, the satisfaction of intervention group patients was higher (84.2% vs 81.2%). The number of people in bad level is about the similar as the number. Conclusion: The seamless nursing measure had positive influence in treatment outcome. The seamless nursing measure had better influence for the patients of gastrointestinal cancer. However, the result of improvement was not significant for the patients of gastrointestinal cancer. Besides, the seamless nursing had better influence for satisfaction on patients of gastrointestinal cancer.

Utility of Prognostic Prediction Models in the Terminal Stage of Gastrointestinal Cancer.

For patients receiving palliative care, information about prognosis is important to help them set priorities and expectations for care and to assist clinicians in decision-making. The purpose of this study was to investigate prognostic models applicable to the terminal stage of gastrointestinal cancer, especially in terms of accuracy of prediction regarding 3-week survival. We validated retrospectively the accuracy of a prognosis prediction model for 354 end-stage gastrointestinal cancer patients who underwent palliative care at our hospital. Using receiver operating characteristic analysis and the area under the curve (AUC), we selected the cut-off value for 3-week survival and evaluated the predictive ability using sensitivity, specificity, positive predictive value, negative predictive value, and accurate diagnosis rate. In our analysis of various models, Palliative Prognostic Index (PPI) and Biological Prognostic Score (BPS) version 3 showed excellent predictive performance with AUCs of 0.85 and 0.83, respectively, and accurate diagnosis rates of 80.0 and 79.0, respectively. BPS version 2 showed fair predictive performance with an AUC of 0.76 and an accurate diagnosis rate of 72.0. Using these models, stratification of prognostic prediction was possible. PPI and BPS were found to be accurate prediction models for short-term survival of terminal gastrointestinal cancer patients.

Can We Accurately Identify Peritoneal Metastases Based on Their Appearance? An Assessment of the Current Practice of Intraoperative Gastrointestinal Cancer Staging.

Peritoneal lesions are common findings during operative abdominal cancer staging. The decision to perform biopsy is made subjectively by the surgeon, a practice the authors hypothesized to be imprecise. This study aimed to describe optical characteristics differentiating benign peritoneal lesions fromperitoneal metastases. The study evaluated laparoscopic images of 87 consecutive peritoneal lesions biopsied during staging laparoscopies for gastrointestinal malignancies from 2014 to 2017. A blinded survey assessing these lesions was completed by 10 oncologic surgeons. Three senior investigators categorized optical features of the lesions. Computer-aided digital image processing and machine learning was used to classify the lesions. Of the 87 lesions, 28 (32%) were metastases. Onexpert survey, surgeons on the average misidentified 36 ± 19% of metastases. Multivariate analysis identified degree of nodularity, border transition, and degree of transparency as independent predictors of metastases (each p < 0.03), with an area under the receiver operating characteristics curve (AUC) of 0.82 (95% confidence interval [CI], 0.72-0.91). Image processing demonstrated no difference using image color segmentation, but showed a difference in gradient magnitude between benign andmetastatic lesions (AUC, 0.66; 95% CI 0.54-0.78; p = 0.02). Machine learning using a neural network with a tenfold cross-validation obtained an AUC of only 0.47. To date, neither experienced oncologic surgeons nor computerized image analysis can differentiateperitoneal metastases from benign peritoneal lesionswith an accuracy that is clinically acceptable. Although certain features correlate with the presence of metastases, a substantial overlap in optical appearance exists between benign and metastatic peritoneal lesions. Therefore, this study suggested the need to perform biopsy for all peritoneal lesions during operative staging, or at least to lower the threshold significantly.

Overall and disease-specific survival of Hodgkin lymphoma survivors who subsequently developed gastrointestinal cancer.

BackgroundHodgkin lymphoma (HL) survivors have an increased risk of gastrointestinal (GI) cancer. This study aims to evaluate whether survival of patients who survived HL and developed GI cancer differs from survival of first primary GI cancer patients.MethodsOverall and cause‐specific survival of GI cancer patients in a HL survivor cohort (GI‐HL, N = 104, including esophageal, gastric, small intestinal, and colorectal cancer) was compared with survival of a first primary GI cancer patient cohort (GI‐1, N = 1025, generated by case matching based on tumor site, gender, age, and year of diagnosis). Cox proportional hazards regression was used for survival analyses. Multivariable analyses were adjusted for GI cancer stage, grade of differentiation, surgery, radiotherapy, and chemotherapy.ResultsGI‐HL cancers were diagnosed at a median age of 54 years (interquartile range 45‐60). No differences in tumor stage or frequency of surgery were found. GI‐HL patients less often received radiotherapy (8% vs 23% in GI‐1 patients, P < 0.001) and chemotherapy (28% vs 41%, P = 0.01) for their GI tumor. Compared with GI‐1 patients, overall and disease‐specific survival of GI‐HL patients was worse (univariable hazard ratio (HR) 1.30, 95% confidence interval (CI) 1.03‐1.65, P = 0.03; and HR 1.29, 95% CI 1.00‐1.67, P = 0.049, respectively; multivariable HR 1.33, 95% CI 1.05‐1.68, P = 0.02; and HR 1.33, 95% CI 1.03‐1.72, P = 0.03, respectively).ConclusionsLong‐term overall and disease‐specific survival of GI cancer in HL survivors is worse compared with first primary GI cancer patients. Differences in tumor stage, grade of differentiation, or treatment could not explain this worse survival.

Diagnostic Endoscopic Ultrasound: Technique, Current Status and Future Directions.

Endoscopic ultrasound (EUS) is now well established as an important tool in clinical practice. From purely diagnostic imaging, it has progressed to include tissue acquisition, which provided the basis for therapeutic procedures. Even as interventional EUS developed, there has been ongoing progress in EUS diagnostic capabilities due to improved imaging systems, better needles for tissue acquisition and development of enhanced imaging functions such as contrast harmonic EUS (CHEUS) and EUS elastography. EUS is well established for differentiation of subepithelial lesions, for T-staging of luminal gastrointestinal and pancreaticobiliary malignancies, for differentiation of benign pancreaticobiliary disorders and for diagnostic tissue acquisition, which can be achieved by EUS-guided fine needle aspiration or by EUS-guided fine needle biopsy using dedicated biopsy needles. This review briefly describes the technique of performing EUS and then discusses its clinical utility in terms of gastrointestinal cancer staging, the evaluation of pancreaticobiliary disorders and tissue acquisition. Enhanced imaging techniques such as CHEUS and EUS elastography are briefly reviewed.

Evaluation of Lymph Nodal Staging and Stiffness of Gastrointestinal Cancers by Intraoperative Ultrasound Elastography

Introduction: Real-time tissue elastography is a new non-invasive method in ultrasonography that differentiates tissues according to their stiffness. The aim of this study was to define the diagnostic value of the intraoperative ultrasound elastography for the differentiation of benign and metastatic regional lymph nodes (LNs) in patients with gastrointestinal (GI) cancers by comparing this technique with the enhanced CT scan, intraoperative palpation by surgeons, and final pathological findings. Furthermore, we examined the factors which prescribed hardness in GI cancers. Methods: Between 2014 and 2016, a total of 70 patients with resectable GI cancer (28 gastric cancers, 42 colon cancers) who underwent operations were enrolled in this study. The LN metastases judged by ultrasound elastography, CT scans, and intraoperative palpation by surgeons were compared with the postoperative pathological results. Stiffness of tumors evaluated by elastography was compared with various pathological findings. Results: A total of 33 (47%) cancers showed LN metastasis. With a cut-off value of 2.5 for the fat tissueto-LN strain index, the respective values for sensitivity, specificity, and overall accuracy were 97%, 85%, and 89% for intraoperative ultrasound elastography; 53%, 93%, and 74% for CT scan; and 60%, 95%, and 79% for palpation by surgeons. Sensitivity and accuracy were found to be significantly higher for intraoperative ultrasound elastography than for CT scan and intraoperative palpation. No significant differences in tumor stiffness among diseases, tumor size and stage. However, significant differences were found in stroma and histological type of tumors. Conclusion: Nodal diagnosis by intraoperative ultrasound elastography could be a reliable and accurate method in GI cancers when compared to other recent modalities. Our data imply that ultrasound elastography could be the best modality during the intraoperative nodal staging of GI cancers. The factors which prescribed stiffness of tumors were stroma, an invasive style, and a histologic type.

Clinical Utility of Positron Emission Tomography Magnetic Resonance Imaging (PET-MRI) in Gastrointestinal Cancers.

Anatomic imaging utilizing both CT (computed tomography) and MRI (magnetic resonance imaging) limits the assessment of cancer metastases in lymph nodes and distant organs while functional imaging like PET (positron emission tomography) scan has its limitation in spatial resolution capacity. Hybrid imaging utilizing PET-CT and PET-MRI are novel imaging modalities that are changing the current landscape in cancer diagnosis, staging, and treatment response. MRI has shown to have higher sensitivity in soft tissue, head and neck pathology, and pelvic disease, as well as, detecting small metastases in the liver and bone compared to CT. Combining MRI with PET allows for detection of metastases that may have been missed with current imaging modalities. In this review, we will examine the clinical utility of FDG PET-MRI in the diagnosis and staging of gastrointestinal cancers with focus on esophageal, stomach, colorectal, and pancreatic cancers. We will also explore its role in treatment response and future directions associated with it.

Clinicopathological analysis of gastric stromal tumor with primary gastrointestinal carcinoma

Objective To analyze the clinicopathological features of gastric stromal tumor with primary gastrointestinal carcinoma. Methods 469 cases of gastrointestinal stromal tumor (GIST) from January 2011 to December 2014 admitted to PLA General Hospital were retrospectively analyzed. Gastric stromal tumor patients with primary gastrointestinal carcinoma were screened. The concomitant gastrointestinal cancer site, stromal tumor size, mitotic activity, immunohistochemistry were also detected. Results The gastric stromal tumor with primary gastrointestinal carcinoma accounted for 14.7 % (69/469) of all the GIST, in which the small gastric stromal tumor accounted for 65.2 % (45/69) of the total and 9.59 % (45/469) of all the GIST. The diameter of all tumors was < 5 cm, and the mitotic was < 5/50 HPF. The positive rates of CD117, CD34, DOG-1 were 92.8 % (64/69), 92.8 % (64/69), 94.1 % (65/69). The Fletcher was classified as low-risk and extreme low-risk. Conclusions Gastric stromal tumor with primary gastrointestinal carcinoma has no specific clinical features and pathological immunohistochemical markers. Its malgnant degree is lower than GIST. Its prognosis is associated with primary gastrointestinal cancer staging. Key words: Gastrointestinal stromal tumors; Small gastric stromal tumor; Primary gastrointestinal tract neoplasms

Exclusion of Gastrointestinal Cancer Patients With Prior Cancer From Clinical Trials: Is This Justified?

BackgroundStrict eligibility criteria are necessary to maintain patient safety and scientific validity in clinical trials. However, this may lead to impaired generalizability of results. As survival in gastrointestinal (GI) cancer relates mainly to the GI malignancy, we hypothesized that previous cancers do not impact on survival and are not a rational exclusion criterion. Materials and MethodsPatients treated with chemotherapy for a GI cancer in 2006 were identified from the electronic patient record at the Royal Marsden Hospital, London. Chart review was performed and patient age, gender, GI cancer stage, prior cancer stage, clinical trial availability/eligibility, and dates of cancer recurrence, death, and last follow-up were collated. ResultsA total of 697 patients were identified. Fifty-four patients (8%) had a prior cancer; commonly breast (26%), prostate (17%), or colon (9%); most were stage I (42%) or II (37%). Two hundred ninety-seven (65%) patients had GI cancer recurrence, 7 (12%) patients had relapse of a prior cancer. Five hundred four (72%) patients have died, 170 (24%) are alive with no cancer, and 23 (3%) patients are alive with cancer. A total of 476 (94%) died of GI cancer, 2 (0.3%) of their prior cancer. Of all patients, 489 (70%) had an available trial, but 30% of patients with a prior cancer were ineligible for this reason. Overall and GI–cancer-specific survival were comparable for patients with/without a prior cancer. ConclusionsSurvival for patients with a GI cancer requiring chemotherapy relates to the GI cancer and rarely a prior cancer. These patients should not be excluded from clinical trial participation.

The Role of Endosonography in the Staging of Gastrointestinal Cancers.

Endosonography (EUS) enables the acquisition of clear images of the gastrointestinal tract wall and the surrounding structures. EUS enables much greater accuracy for staging decisions compared to computed tomography. Surgery for esophageal cancer has a high rate of morbidity and mortality, and it is important to decide on an appropriate treatment method through pre-surgical evaluation. Minimal invasive surgery is widely used for the treatment of gastrointestinal cancer, and endoscopic submucosal dissection is a safe treatment method for early cancer of the gastrointestinal tract that does not result in lymph node metastasis. EUS is essential for pre-surgical evaluation for all esophageal cancers. The use of EUS can effectively reduce unnecessary surgeries and thereby allow for appropriate treatment planning for patients. A number of different diagnostic modalities are available, but EUS is still the mainstay for pre-surgical evaluation of esophageal cancer. The role of EUS for early stomach cancer treatment as a tool for determining the need for endoscopic resection and for pre-surgical assessment is increasing.

Interpretation of D2 radical operation and en bloc mesogastric excision in gastric cancer

As a surgical oncology concept, complete mesenteric excision has been widely accepted. As to different organs, in addition to the rectum and the colon, the range or the criteria of the so-called complete mesenterium is not yet entirely clear. For the stomach, the mesogastric structure is so complicated, and the embryology and anatomy of the mesogastrium or the perigastric ligaments differed significantly. Even to perform a resection in accordance with the anatomy plane of mesogatrium, the mesogastric plane is still extended as compared to the current standard D2 radical resection. We therefore propose the concept of surgical mesogastrium, which means that the essence of en bloc mesogastric excision (EME) should be surgical mesogastric resection. In clinical practice, we found that a lot of symmetric similarity exists in stomach and colon, the morphological transformation from stomach to the colon can be accomplished to some extent by extension and folding of the stomach, and striking match exists in the morphology, distribution of the blood vessels, lymphatic drainage and mesenterium (mesogastrium or mesocolon). On this basis, we propose the plane of the surgical mesogastrium, which includes the gastrohepatic ligament, hepatoduodenal ligament, hepatopancreatic folds, splenicpancreatic folds, gastrophrenic ligament, gastrosplenic ligament, gastrocolic ligament (supracolic omentum) and omentum. This surgical mesogastric plane coincides with the current plane of D2 radical resection. This paper further discussed the N staging of gastric cancer. By comparative study of the stomach and the colon, we could re-classify the stomach-associated lymph nodes into three groups, the perigastric, the middle and the roots, which may resolve the long-standing controversy between the Eastern and Western regarding this issue. In addition, we also agree with the presence of lymph node metastasis in the plane outside of the surgical mesogastrium, the so-called lateral lymph node metastasis. As for the N staging of gastrointestinal cancer, we must firstly define the lymph node metastasis as mesenteric (mesogastric or mesocolic lymph node) and extra-mesenteric (later lymph node). In case of lateral lymph node metastasis, which should be considered as M1 stage (distant metastasis) unless there is evidence to suggest lateral lymph node metastasis, otherwise extended lateral lymph node dissection should be avoided. In case of mesenteric (mesogastric or mesocolic) lymph node metastasis, classification should be in accordance with the current NCCN guideline, which was divided by the number of lymph node metastasis (N1-N3).

Long-term survival among Hodgkin's lymphoma patients with gastrointestinal cancer: a population-based study

The increased risk of gastrointestinal (GI) cancers after Hodgkin's lymphoma (HL) is well established. However, no large population-based study has described the actuarial survival after subsequent GI cancers in HL survivors (HL-GI). For 209 patients with HL-GI cancers (105 colon, 35 stomach, 30 pancreas, 21 rectum, and 18 esophagus) and 484 165 patients with first primary GI cancers (GI-1), actuarial survival was compared, accounting for age, gender, race, GI cancer stage, radiation for HL, and other variables. Though survival of HL patients who developed localized stage colon cancer was similar to that of the GI-1 group, overall survival (OS) of HL patients with regional or distant stage colon cancer was reduced [hazard ratio, (HR)=1.46, P=0.01]. The HL survivors with regional or distant stage colon cancer in the transverse segment had an especially high risk of mortality (HR: 2.7, P=0.001 for OS). For localized stomach cancer, OS was inferior among HL survivors (HR=3.46, P=0.006). The HL patients who develop GI cancer experience significantly reduced survival compared with patients with a first primary GI cancer. Further research is needed to explain the inferior survival of HL patients and to define selection criteria for cancer screening in HL survivors.

Transgastric pure-NOTES peritoneoscopy and endoscopic ultrasonography for staging of gastrointestinal cancers: a survival and feasibility study

Human natural orifice transluminal endoscopic surgery (NOTES) has mainly been based on simultaneous laparoscopic assistance (hybrid NOTES), forgoing the theoretical benefits of the NOTES technique. This is due to a lack of NOTES-specific instruments and endoscopes, making pure-NOTES procedures difficult and time consuming. An area where pure NOTES could be adopted at its present stage of development is minimally invasive staging of gastrointestinal (GI) cancer. The aim of this study is to evaluate the feasibility of combining transgastric (TG) pure-NOTES peritoneoscopy and intraperitoneal endoscopic ultrasonography (ip-EUS) with intraluminal EUS (il-EUS) for peritoneal evaluation. This was a feasibility and survival study where il-EUS followed by ip-EUS and peritoneoscopy was performed in 10 pigs subjected to TG pure NOTES. A score was given with regard to achieved visualisation of predefined anatomical structures. Survival was assessed at postoperative day (POD) 14. All animals survived until POD 14. Median total procedural time was 94 min (range 74-130 min). Median time for il-EUS, ip-EUS and peritoneoscopy was 11 min (range 7-14 min), 13 min (range 8-20 min) and 10 min (range 6-23 min). Il-EUS, ip-EUS and peritoneoscopy resulted in a score of 15/15 points (range 14-15 points), 6/9 points (range 1-8 points) and 12/13 points (range 8-13 points). TG pure-NOTES peritoneoscopy and ip-EUS combined with il-EUS is feasible and provides sufficient peritoneal evaluation. The technique could have potential for minimally invasive staging of GI cancers.

Long-term survival among Hodgkin lymphoma (HL) patients with gastrointestinal (GI) cancers: A population-based study.

8037 Background: The markedly increased risk of GI cancers after HL is well-established, with GI tumors accounting for the 3rd largest absolute risk of second cancers. However, no large, population-based studies have described overall survival (OS) and cause-specific survival (CSS) of HL survivors who developed GI cancers (HL-GI). Methods: For 209 HL-GI patients (105 colon, 35 stomach, 30 pancreas, 21 rectum, 18 esophagus) and 484,165 patients with first primary GI cancers (GI-1), actuarial OS and CSS were compared, accounting for age, gender, race, SES, GI cancer stage, radiation (RT) for HL, and other variables. Radiation doses to ascending, transverse, and descending colon with standard para-aortic and inverted-Y RT fields were estimated using water and anthropomorphic phantoms. Results: Survival of HL-GI group was inferior compared to GI-1 for most sites (Table). For localized stomach cancer, OS was more than three times worse among HL survivors. Whereas survival of HL patients who developed localized colon cancer (CC) was similar to that of GI-1 group, OS of HL patients with regional or distant CC was reduced 50%. HL survivors with regional or distant CC (transverse segment) had especially high risks of mortality (hazard ratios: 2.7 and 2.6; P=0.001 and 0.002 for OS and CSS respectively). Despite similarities in GI cancer stage between most HL-GI and GI-1 sites, transverse colon cancer was diagnosed at significantly more advanced stages in HL-GI vs. GI-1 (P=0.024). Dosimetry modeling of abdominal RT showed that transverse colon received 81% of total dose (vs. 4-43% to other segments). Conclusions: HL patients who develop GI cancer have significantly reduced survival compared to patients with a first primary cancer in GI sites. Further research is needed to explain the inferior survival of HL patients and to define selection criteria for screening colonoscopies in HL survivors. OS hazard ratios (HR) from Cox model. Localized Regional/distant GI cancer site HR (P value) HR (P value) Colon 1.3 (0.40) 1.5 (0.01) Stomach 3.5 (0.006) 1.0 (0.8) Pancreas Sample size too small for analysis 1.1 (0.6) Rectum 1.7 (0.19) 2.1 (0.06) Esophagus 4.3 (0.012) 0.8 (0.46)

Interventional Endoscopic Ultrasound: The Next Frontier in Gastrointestinal Endoscopy

Endoscopic ultrasound (EUS) has become well established as a diagnostic modality in gastrointestinal cancer staging. It offers high-resolution imaging and fine-needle biopsy, which is essential in tumor and nodal staging of gastrointestinal cancers. In the recent decade, however, many therapeutic applications of EUS have become possible. Currently, interventional EUS endoscopy involves celiac plexus neurolysis, pseudocyst drainage, and intratumoral fine-needle injection therapy for inoperable pancreatic malignancy. Emerging techniques include the accurate endoscopic delivery of radioactive beads to localize tumor therapy as well as other therapies, such as radiofrequency ablation or cryotherapy. Diagnostic and therapeutic access to the biliary tree and pancreatic duct is increasingly being used successfully in failed endoscopic retrograde cholangiopancreatography (ERCP) procedures. This review discusses these procedures and several evolving future applications, including vascular access and EUS-guided enteral anastomosis.

Minimally invasive surgery and cancer: controversies part 1.

Perhaps there is no more important issue in the care of surgical patients than the appropriate use of minimally invasive surgery (MIS) for patients with cancer. Important advances in surgical technique have an impact on early perioperative morbidity, length of hospital stay, pain management, and quality of life issues, as clearly proved with MIS. However, for oncology patients, historically, the most important clinical questions have been answered in the context of prospective randomized trials. Important considerations for MIS and cancer have been addressed, such as what are the important immunologic consequences of MIS versus open surgery and what is the role of laparoscopy in the staging of gastrointestinal cancers? This review article discusses many of the key controversies in the minimally invasive treatment of cancer using the pro–con debate format.