The Experts below are selected from a list of 17979 Experts worldwide ranked by ideXlab platform
Tatsuo Hattori - One of the best experts on this subject based on the ideXlab platform.
-
Clinicopathologic Comparison of Siewert Type II and III Adenocarcinomas of the Gastroesophageal Junction
World Journal of Surgery, 2006Co-Authors: Norihiro Yuasa, Hideo Miyake, Tatsuharu Yamada, Tomoki Ebata, Yuji Nimura, Tatsuo HattoriAbstract:Background Since Misumi et al. and Siewert proposed a new classification for carcinoma of the Gastroesophageal Junction (GEJ), few surgical studies using these criteria have been reported from Eastern countries. Siewert type II adenocarcinomas are managed using general rules for either gastric or esophageal cancer. We set out to determine whether type II adenocarcinoma is a distinct clinical entity requiring a more specific treatment plan. Methods Among 125 Japanese patients who underwent resection of adenocarcinoma of the GEJ (type I, 2; type II, 44; type III, 79), 101 who underwent R0 resections (type II, 40; type III, 61) were analyzed to evaluate surgical results and compare clinicopathologic factors. Results Barrett’s epithelium was recognized in two patients with type II adenocarcinoma. Type II differed significantly from type III in higher prevalence of Borrmann macroscopic type 2, more frequent lymph node metastasis (58% vs. 34%), higher metastatic rate to lower mediastinal lymph nodes (13%), increased risk of hepatic recurrence, and lower 5-year survival after R0 resection (67.4% vs. 87.1%). Conclusions Clinicopathologic differences were evident between type II and III adenocarcinomas. Siewert type II adenocarcinoma differs sufficiently to be considered a clinical entity distinct and independent from type III.
Jennifer Straatman - One of the best experts on this subject based on the ideXlab platform.
-
Techniques and short-term outcomes for total minimally invasive Ivor Lewis esophageal resection in distal esophageal and Gastroesophageal Junction cancers: pooled data from six European centers
Surgical Endoscopy, 2017Co-Authors: Jennifer Straatman, Nicole Wielen, Grard A. P. Nieuwenhuijzen, Camiel Rosman, Josep Roig, Joris J. G. Scheepers, Miguel A. Cuesta, Misha D. P. Luyer, Mark I. Berge Henegouwen, Frans WorkumAbstract:Introduction Esophagectomy for cancer can be performed in a two-stage procedure with an intrathoracic anastomosis: the Ivor Lewis esophagectomy. A growing incidence of distal and Gastroesophageal Junction adenocarcinomas and increasing use of minimally invasive techniques have prompted interest in this procedure. The aim of this study was to assess short-term results of minimally invasive Ivor Lewis esophagectomy (MIE-IL). Methods A retrospective cohort study was performed from June 2007 until September 2014, including patients that underwent MIE-IL for distal esophageal and Gastroesophageal Junction cancer in six different hospitals in the Netherlands and Spain. Data were collected with regard to operative techniques, pathology and postoperative complications. Results In total, 282 patients underwent MIE-IL, of which 90.2 % received neoadjuvant therapy. Anastomotic leakage was observed in 43 patients (15.2 %), of whom 13 patients (4.6 %) had empyema, necessitating thoracotomy for decortication. With an aggressive treatment of complications, the 30-day and in-hospital mortality rate was 2.1 %. An R0-resection was obtained in 92.5 % of the patients. After neoadjuvant therapy, 20.1 % of patients had a complete response. Conclusions Minimally invasive Ivor Lewis esophagectomy for distal esophageal and Gastroesophageal Junction adenocarcinomas is an upcoming approach for reducing morbidity caused by laparotomy and thoracotomy. Anastomotic leakage rate is still high possibly due to technical diversity of anastomotic techniques, and a high percentage of patients treated by neoadjuvant chemoradiotherapy. An aggressive approach to complications leads to a low mortality of 2.1 %. Further improvement and standardization in the anastomotic technique are needed in order to perform a safe intrathoracic anastomosis.
-
techniques and short term outcomes for total minimally invasive ivor lewis esophageal resection in distal esophageal and Gastroesophageal Junction cancers pooled data from six european centers
Surgical Endoscopy and Other Interventional Techniques, 2017Co-Authors: Jennifer Straatman, Grard A. P. Nieuwenhuijzen, Camiel Rosman, Josep Roig, Joris J. G. Scheepers, Miguel A. Cuesta, Misha D. P. Luyer, Nicole Van Der Wielen, Mark I Van Berge Henegouwen, Frans Van WorkumAbstract:Esophagectomy for cancer can be performed in a two-stage procedure with an intrathoracic anastomosis: the Ivor Lewis esophagectomy. A growing incidence of distal and Gastroesophageal Junction adenocarcinomas and increasing use of minimally invasive techniques have prompted interest in this procedure. The aim of this study was to assess short-term results of minimally invasive Ivor Lewis esophagectomy (MIE-IL). A retrospective cohort study was performed from June 2007 until September 2014, including patients that underwent MIE-IL for distal esophageal and Gastroesophageal Junction cancer in six different hospitals in the Netherlands and Spain. Data were collected with regard to operative techniques, pathology and postoperative complications. In total, 282 patients underwent MIE-IL, of which 90.2 % received neoadjuvant therapy. Anastomotic leakage was observed in 43 patients (15.2 %), of whom 13 patients (4.6 %) had empyema, necessitating thoracotomy for decortication. With an aggressive treatment of complications, the 30-day and in-hospital mortality rate was 2.1 %. An R0-resection was obtained in 92.5 % of the patients. After neoadjuvant therapy, 20.1 % of patients had a complete response. Minimally invasive Ivor Lewis esophagectomy for distal esophageal and Gastroesophageal Junction adenocarcinomas is an upcoming approach for reducing morbidity caused by laparotomy and thoracotomy. Anastomotic leakage rate is still high possibly due to technical diversity of anastomotic techniques, and a high percentage of patients treated by neoadjuvant chemoradiotherapy. An aggressive approach to complications leads to a low mortality of 2.1 %. Further improvement and standardization in the anastomotic technique are needed in order to perform a safe intrathoracic anastomosis.
Stuart J Spechler - One of the best experts on this subject based on the ideXlab platform.
-
Intestinal metaplasia at the Gastroesophageal Junction: Barrett’s, bacteria, and biomarkers
The American journal of gastroenterology, 2003Co-Authors: Carrnela P. Morales, Stuart J SpechlerAbstract:For patients found to have intestinal metaplasia at the Gastroesophageal Junction, technical problems can make it difficult to distinguish short-segment Barrett's esophagus from intestinal metaplasia of the gastric cardia. Whereas the risk of malignancy for the former condition seems to be higher than that for the latter, the distinction between these conditions can have practical clinical implications. Immunostaining for cytokeratins has been proposed as a means to distinguish intestinal metaplasia of esophageal and gastric origins. We review recent data on this issue, and conclude that immunostaining for cytokeratins has no clear advantages over other biomarkers that have been proposed for identifying Barrett's esophagus (e.g., mucin histochemistry, mAb Das-1 immunoreactivity). Presently, the importance of intestinal metaplasia at the Gastroesophageal Junction remains unclear, and the clinical utility of biomarkers in distinguishing short-segment Barrett's esophagus from intestinal metaplasia of the gastric cardia has not yet been established.
-
the role of gastric carditis in metaplasia and neoplasia at the Gastroesophageal Junction
Gastroenterology, 1999Co-Authors: Stuart J SpechlerAbstract:Adenocarcinomas at the Gastroesophageal Junction appear to arise from foci of intestinal metaplasia that develop either in the distal esophagus or the proximal stomach (the gastric cardia). Metaplasia is usually a consequence of chronic inflammation, and it is logical to assume that intestinal metaplasia at the Gastroesophageal Junction develops as a result of chronic inflammation in the epithelia that normally line the Junction region. Intestinal metaplasia in the esophagus is known to be a sequela of chronic inflammation in squamous epithelium caused by Gastroesophageal reflux disease, whereas intestinal metaplasia in the distal stomach is often a consequence of chronic gastritis caused by Helicobacter pylori infection. For the gastric cardia, the contributions of Gastroesophageal reflux disease, H. pylori infection, and other factors to inflammation, metaplasia, and neoplasia are not clear. If physicians are to develop meaningful preventive strategies and specific therapies for tumors of the proximal stomach, a clear understanding of pathogenesis is important. Recent studies on pathogenetic factors for inflammation in cardiac epithelium (gastric carditis) have yielded contradictory results, perhaps because of fundamental differences in the techniques used by different investigators for identifying and sampling the gastric cardia. This report explores the roots of the controversy regarding the role of gastric carditis in the development of metaplasia and neoplasia at the Gastroesophageal Junction and suggests practical guidelines for biopsy protocols to be used in future studies that will be necessary to resolve these disputes.
-
proliferative characteristics of intestinalized mucosa in the distal esophagus and Gastroesophageal Junction short segment barrett s esophagus a case control study
Human Pathology, 1999Co-Authors: James M Gulizia, Donald A Antonioli, Stuart J Spechler, John M Zeroogian, Raj K Goyal, Ali Shahsafaei, Yen Yi Chen, Helen H Wang, Robert D OdzeAbstract:Abstract Intestinalized epithelium in traditional long-segment Barrett's esophagus (BE) shows increased proliferative activity, which is postulated to be an early step in the metaplasia-dysplasia-carcinoma sequence. The aim of this study was to evaluate the proliferative activity of intestinalized epithelium of the distal esophagus and Gastroesophageal Junction (IMEGEJ). Tissue sections from 78 consecutive patients (20 with IMEGEJ, 58 without IMEGEJ) who had elective upper gastrointestinal endoscopy over a 6-month period were immunohistochemically stained with MIB-1, the Ki-67 proliferation-antigen-associated marker, for evaluation of the crypt MIB-1 proliferation index (PI), size of the proliferative zone (PZ), and the presence of surface epithelial staining. Data from the IMEGEJ and non-IMEGEJ groups, and from 15 age-matched patients with traditional long-segment BE (>3.0 cm), were compared statistically. IMEGEJ patients showed a statistically significant increase in the mean crypt PI compared with non-IMEGEJ controls (21.9 ± 19.5 v 14.3 ± 9.3; P = .01). In addition, IMEGEJ cases showed an increase in the mean crypt PZ (52.3 ± 16.4 v 45.2 ± 17.2; P = .05), and a trend toward an increase in the percentage of cases with MIB-1-positive surface epithelial cells (50% v 33%, P = .18). Patients with IMEGEJ did not differ from patients without IMEGEJ with respect to any other clinical or histological feature, including signs or symptoms of Gastroesophageal reflux disease and presence or absence of esophagitis or carditis. The MIB-1 results of the patients with long-segment BE (MIB-1 PI=22.6 ± 20.5, MIB-1 PZ=51.8 ± 19.6, proportion of cases with MIB-1—positive surface cells=66%) were similar to those with IMEGEJ. Intestinalized epithelium in the distal esophagus or Gastroesophageal Junction shows increased proliferative activity in comparison with patients without intestinalized epithelium. This finding supports an increased risk of carcinogenesis in patients with IMEGEJ.
Norihiro Yuasa - One of the best experts on this subject based on the ideXlab platform.
-
Clinicopathologic Comparison of Siewert Type II and III Adenocarcinomas of the Gastroesophageal Junction
World Journal of Surgery, 2006Co-Authors: Norihiro Yuasa, Hideo Miyake, Tatsuharu Yamada, Tomoki Ebata, Yuji Nimura, Tatsuo HattoriAbstract:Background Since Misumi et al. and Siewert proposed a new classification for carcinoma of the Gastroesophageal Junction (GEJ), few surgical studies using these criteria have been reported from Eastern countries. Siewert type II adenocarcinomas are managed using general rules for either gastric or esophageal cancer. We set out to determine whether type II adenocarcinoma is a distinct clinical entity requiring a more specific treatment plan. Methods Among 125 Japanese patients who underwent resection of adenocarcinoma of the GEJ (type I, 2; type II, 44; type III, 79), 101 who underwent R0 resections (type II, 40; type III, 61) were analyzed to evaluate surgical results and compare clinicopathologic factors. Results Barrett’s epithelium was recognized in two patients with type II adenocarcinoma. Type II differed significantly from type III in higher prevalence of Borrmann macroscopic type 2, more frequent lymph node metastasis (58% vs. 34%), higher metastatic rate to lower mediastinal lymph nodes (13%), increased risk of hepatic recurrence, and lower 5-year survival after R0 resection (67.4% vs. 87.1%). Conclusions Clinicopathologic differences were evident between type II and III adenocarcinomas. Siewert type II adenocarcinoma differs sufficiently to be considered a clinical entity distinct and independent from type III.
Frans Van Workum - One of the best experts on this subject based on the ideXlab platform.
-
techniques and short term outcomes for total minimally invasive ivor lewis esophageal resection in distal esophageal and Gastroesophageal Junction cancers pooled data from six european centers
Surgical Endoscopy and Other Interventional Techniques, 2017Co-Authors: Jennifer Straatman, Grard A. P. Nieuwenhuijzen, Camiel Rosman, Josep Roig, Joris J. G. Scheepers, Miguel A. Cuesta, Misha D. P. Luyer, Nicole Van Der Wielen, Mark I Van Berge Henegouwen, Frans Van WorkumAbstract:Esophagectomy for cancer can be performed in a two-stage procedure with an intrathoracic anastomosis: the Ivor Lewis esophagectomy. A growing incidence of distal and Gastroesophageal Junction adenocarcinomas and increasing use of minimally invasive techniques have prompted interest in this procedure. The aim of this study was to assess short-term results of minimally invasive Ivor Lewis esophagectomy (MIE-IL). A retrospective cohort study was performed from June 2007 until September 2014, including patients that underwent MIE-IL for distal esophageal and Gastroesophageal Junction cancer in six different hospitals in the Netherlands and Spain. Data were collected with regard to operative techniques, pathology and postoperative complications. In total, 282 patients underwent MIE-IL, of which 90.2 % received neoadjuvant therapy. Anastomotic leakage was observed in 43 patients (15.2 %), of whom 13 patients (4.6 %) had empyema, necessitating thoracotomy for decortication. With an aggressive treatment of complications, the 30-day and in-hospital mortality rate was 2.1 %. An R0-resection was obtained in 92.5 % of the patients. After neoadjuvant therapy, 20.1 % of patients had a complete response. Minimally invasive Ivor Lewis esophagectomy for distal esophageal and Gastroesophageal Junction adenocarcinomas is an upcoming approach for reducing morbidity caused by laparotomy and thoracotomy. Anastomotic leakage rate is still high possibly due to technical diversity of anastomotic techniques, and a high percentage of patients treated by neoadjuvant chemoradiotherapy. An aggressive approach to complications leads to a low mortality of 2.1 %. Further improvement and standardization in the anastomotic technique are needed in order to perform a safe intrathoracic anastomosis.
