AI Article Synopsis
- The study investigated the risks of lymph node metastasis (LNM) and treatment outcomes in patients with early esophago-gastric (EG) adenocarcinoma, focusing on the effectiveness of endoscopic resection (ER) versus radical surgery.
- A retrospective analysis was conducted using data from 1,601 patients across 26 UK centers, revealing that the overall LNM rate was 13.5% and highlighting certain tumor characteristics that may indicate higher risks, although these factors did not predict LNM rates or survival outcomes significantly.
- The findings suggest a need to reevaluate the predictive factors for LNM in early EG adenocarcinoma and emphasize the importance of further research to better identify patients suitable for either organ-preserving
Article Abstract
Objective: The aim of this study was to quantify LNM risk and outcomes following treatment of early esophago-gastric (EG) adenocarcinoma.
Background: The standard of care for early T1N0 EG cancer is endoscopic resection (ER). Radical surgical resection is recommended for patients perceived to be at risk of lymph node metastasis (LNM). Current models to select organ-preserving vs. surgical treatment are inconsistent.
Methods: CONGRESS is a UK-based multicentre retrospective cohort study. Patients diagnosed with clinical or pathological T1N0 EG adenocarcinoma from 2015-2022 were included. Outcomes and rates of LNM were assessed. Cox regression was performed to assess the impact of prognostic and treatment factors on overall survival.
Results: 1,601 patients from 26 centres were included, with median follow-up 32 months(IQR 14-53). 1285/1612(80.3%) underwent ER, 497/1601(31.0%) underwent surgery. Overall rate of LNM was 13.5%. On ER staging, tumour depth (T1bsm2-3 17.6% vs. T1a 7.1%), lymphovascular invasion (17.2% vs. 12.6%), or signet cells (28.6% vs. 13.0%) were associated with LNM. In multivariable regression analysis, these were not significantly associated with LNM rates or survival. Adjusting for demographic and tumour variables, surgery after ER was associated with significant survival benefit, HR 0.33(0.15-0.77),P=0.010.
Conclusion: This large multicentre dataset suggests that early EG adenocarcinoma is associated with significant risk of LNM. This data is representative of current real clinical practice with ER-based staging, and suggests previously held beliefs regarding reliability of predictive factors for LNM may need to be reconsidered. Further research to identify patients who may benefit from organ-preserving vs. surgical treatment is urgently required.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/SLA.0000000000006496 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Reflecting on the impact of the COVID pandemic on patient management and its subsequent influence on long-term outcomes: a case-control study in the field of esophago-gastric cancer.
World J Surg Oncol
January 2025
Department of Oesophago-Gastric & Bariatric Surgery, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Salford Royal Hospital, Manchester, UK.
Background: The delivery of cancer services changed significantly during the COVID-19 pandemic. This study aimed to describe changes in presentations, assess the change in recommendations by the MDT during the pandemic, and describe the subsequent long-term impact of these changes on survival rates in patients with EG cancer.
Methods: A retrospective cohort study was designed comparing three patient groups of those referred to EG MDT in the same 6-month period pre-pandemic (PP;2019) during the initial phase of the pandemic (P1;2020) and the year after the initial phase (P2;2021).
REsolution of Symptoms afTer Oesophago-gastric cancer REsection delphi (RESTOREd)-standardizing the definition, investigation and management of gastrointestinal symptoms and conditions after surgery.
Br J Surg
November 2024
Department of Gastroenterology, United Lincolnshire Hospitals NHS Trust, Lincoln, UK.
Background: Oesophago-gastric cancer surgery negatively affects quality of life with a high postoperative symptom burden. Several conditions that may be diagnosed and treated after surgery are recognised. However, consensus regarding their definition and management is lacking.
View Article and Find Full Text PDF[Prevalence and potential risk factors for nodal metastasis in early esophago-gastric adenocarcinoma-Results of the CONGRESS study].
Chirurgie (Heidelb)
January 2025
Klinik für Allgemein‑, Viszeral‑, Thorax- und Transplantationschirurgie, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
Altered Microbiome Promotes Pro-Inflammatory Pathways in Oesophago-Gastric Tumourigenesis.
Cancers (Basel)
October 2024
Department of Upper GI Surgery, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK.
Introduction: The upper gastrointestinal microbiome is a dynamic entity that is involved in numerous processes including digestion, production of vitamins and protection against pathogens. Many external and intrinsic factors may cause changes in the proportions of bacteria within the microbial community, termed 'dysbiosis'. A number of these have been identified as risk factors for a range of diseases, including oesophago-gastric carcinoma.
View Article and Find Full Text PDFPredictive Factors for the Development of Gallbladder Necrosis.
Cureus
August 2024
Northern Oesophago-Gastric Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, GBR.
Introduction Acute cholecystitis is a common complication of gallstone disease. Likewise, gallbladder necrosis is a complication of cholecystitis associated with higher risks of morbidity and mortality. Identification of risk factors which portend to gallbladder necrosis is key in prioritizing the management of higher-risk patients.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!