[Show abstract][Hide abstract] ABSTRACT: Longterm survival after curative resection for adenocarcinoma at the gastro-esophageal junction (GEJ) range between 18% and 50%. In the pivotal Intergroup-0116 Phase III trial by Macdonald et all, adjuvant chemoradiotherapy improved both disease-free and overall survival in curatively resected patients with mainly gastric adenocarcinoma. We compared survival data for curatively resected patients with adeno-carcinoma solely at the gastro-esophageal junction (GEJ), treated with surgery alone or surgery and adjuvant chemoradio-therapy.
From 2003 to 2009, 211 patients underwent curative resection. Surgery alone was performed in 95 pa-tients and 116 patients received adjuvant therapy after resection. All patients underwent Lewis-Tanner operation with D1 node resection including coliac nodes (D1+). Informations about recurrence and death were collected from the Danish Cancer Register and the Central Death Register. Patients who died after experiencing severe complications after surgery were excluded from the survival analysis. Patients with T0N0 or T1N0 were also excluded because patients of this category were not given adjuvant therapy according to the Macdonald protocol.
Patients with positive node status in the resected specimen, the 3-year disease-free survival after adjuvant chemoradiotherapy (n = 91) or surgery alone (n = 43) was 24% and 37%, respectively. Median time of survival was prolonged by 10 month in favour of those who received chemoradiotherapy. However, after controlling for the confounding effect of age and node status, only positive node status in the resected specimen had significant partial effect on survival.
Chemoradiotherapy according to the Intergroup-0116 protocol might still be a reasonable option after curative resection in patients with GEJ adenocarcinomas and positive lymph node status, who did not receive neoadjuvant chemotherapy.
Preview · Article · Mar 2012 · Scandinavian journal of surgery: SJS: official organ for the Finnish Surgical Society and the Scandinavian Surgical Society
[Show abstract][Hide abstract] ABSTRACT: We present the long-term survival after curative resection for cancer at the gastro-oesophageal junction.
From 1992 through 2003, 147 patients with cancer at the gastro-oesophageal junction underwent curative resection. Preoperative evaluation included a computed tomography (CT) scan of the thorax and abdomen, gastroscopy, endoscopic ultrasonography and ultrasonography of the neck.
Explorative laparotomy was performed in 466 patients, and 147 underwent curative resection, while 319 had advanced disease. No patients received adjuvant chemo-radiotherapy. Adenocarcinoma was found in 93% of the patients and squamous cell carcinoma in 7%. Cardia resection was performed in 78%, while 22% underwent gastrectomy. R0 resection was performed in 95% of the operations. Anastomotic dehiscence was seen in 4%. The perioperative mortality after curative resection was 3% and the 180-day-mortality was 5%. The observed five-year survival rate after curative operation was 29% and the estimated five-year survival was 24%. The five-year survival rates according to tumour stage (T1-4) were 85%, 40%, 23% and 25%, respectively. After stratification according to lymph node metastases (-/+metastases) and age below/above 70 years, five-year survival rates were 41%/ 19% and 32%/17%, respectively. Cox regression analysis showed that no metastases (N0) and age below 70 years were independent predictors of survival.
The overall and stage-dependent survival after five years, perioperative mortality and complications are acceptable and comparative to those reported by foreign centres.
No preview · Article · May 2010 · Ugeskrift for laeger
[Show abstract][Hide abstract] ABSTRACT: Reading a wireless capsule endoscopy (WCE) may be time-consuming. In order to reduce the time needed by a physician to view a WCE, we investigated if other medical professions could preview the video and detect bowel pathology in advance.
A specialist in gastroenterology and two laboratory technicians independently viewed 34 consecutive WCEs and noted all findings. Thereafter, two specialists reviewed the findings made by the technicians independently in order to make a diagnosis. The results were compared with the diagnosis made by the first specialist, who viewed the entire WCE himself.
The reviewing specialists were able to make a correct diagnosis based on the technicians' findings in 97% and 85% of the patients, respectively.
The study indicates that it is safe and timesaving to use other medical professions than physicians to preview WCEs.
No preview · Article · Nov 2006 · Ugeskrift for laeger
[Show abstract][Hide abstract] ABSTRACT: Part II of the guidelines contains a description of epidemiology, histopathology, clinical presentation, diagnostic procedure, treatment, and survival for each type of neuroendocrine tumour. We are not only including gastroenteropancreatic tumours but also bronchopulmonary and thymic neuroendocrine tumours. These guidelines essentially cover basic knowledge in the diagnosis and management of the different forms of neuroendocrine tumour. We have, however, tried to give more updated information about the epidemiology and histopathology, which is essential for the clinical management of these tumours.
[Show abstract][Hide abstract] ABSTRACT: The incidence of neuroendocrine tumours of the gastroenteropancreatic system seems to have increased during the past decade. New diagnostic and therapeutic procedures have aroused the interest of physicians, though most see very few cases of such diseases. A group of members of the Nordic Neuroendocrine Tumour Group decided to compile some guidelines to facilitate the diagnosis and treatment of patients with these tumours. Part I of these guidelines discusses the principles of histopathology, biochemical and radiological diagnosis as well as therapeutic options.