Hope from Japan for esophagogastric cancers: esophagectomy and endoscopic submucosal dissection for gastric tube cancer

Autor: Christos Katsios, Georgios Baltogiannis, Dimitrios H Roukos
Rok vydání: 2010
Předmět:
Zdroj: Surgical endoscopy. 24(11)
ISSN: 1432-2218
Popis: Westerns surgeons, oncologists, and pathologists are debating: Can the excellent results from early detection and treatment of tumors in the upper gastrointestinal tract reported from Japan and other Asian countries be achieved in the U.S. or Europe? Various reasons have been given to explain the poor survival of patients with gastric and esophageal cancers in the West. Some questions such as what are the effects of the biological, genetic, and molecular differences of cancer genomes between Asian and European ancestry patients remain unanswered. However, these cancer genome differences may only partly explain the better oncological outcomes of Japanese patients. In fact, we in the West should learn from our colleagues in Japan to make better use of screening programs, standardized D2 surgery for gastric cancer, and surveillance after treatment. An example of good practice is the recent 70% 5-year survival rate in advanced stages II and III gastric cancer patients reported by a large-scale multicenter randomized controlled trial in Japan [1, 2]. Therefore, the previous criticism that Japanese studies are limited by the retrospective nature of their analyses and should be considered with caution should now clearly be revised. The prognosis of esophageal carcinoma is dismal. Follow-up data from Cancer Facts and Statistics in the U.S. reveal that esophageal cancer, along with pancreatic and lung cancer, has a very high mortality rate [3]. This suggests that the disease is nearly incurable except when diagnosed at early stage I. Despite the disappointing data, appropriate medical efforts and careful management can not only save some patients but can also improve their quality of life (QOL). Indeed, in support of this statement is the recent report in this journal by Bamba et al. [4]. The authors evaluated the follow-up data of their patients who had undergone esophagectomy to assess whether endoscopic surveillance in these patients is justified. Among 881 patients who underwent esophagectomy for esophageal cancer in Niigata University Medical and Dental Hospital between 1976 and 2006, the authors identified 551 patients in whom a gastric tube was used as an esophageal substitute. Twenty-five patients with 29 gastric tube cancer (GTC) lesions treated between 1989 and 2007 were analyzed retrospectively. The 10-year cumulative incidence rate of GTC was 8.6%. Endoscopic surveillance identified GTC lesions in 95% (17/18) of asymptomatic patients leading to endoscopic submucosal dissection (ESD) in 15 (88%) of them. Overall, pathological examination of the resected specimen after ESD showed a complete (R0) resection in 90% of the GCT cases, whereas it was only 14.3% among 7 patients treated with endoscopic mucosal resection (EMR). No cancer recurrence developed during a median follow-up period of 24 months among the 17 asymptomatic patients. The authors emphasize the need for endoscopic surveillance of patients with a gastric tube after esophagectomy. This approach allows curative treatment with ESD. This study has many important messages useful for dayto-day high-quality clinical practice. Based on a high GTC incidence rate at 10 years (8%), early detection of GTC mostly in asymptomatic patients, and excellent oncological and QOL outcomes after ESD, the authors correctly recommend endoscopic surveillance. However, there are some C. Katsios D. H. Roukos (&) G. Baltogiannis Department of Surgery, University of Ioannina, School of Medicine, 451 10 Ioannina, Greece e-mail: droukos@uoi.gr
Databáze: OpenAIRE
Externí odkaz: