Neoadjuvant Therapy in Esophageal Cancer
Locally advanced esophageal cancer has a dismal prognosis. Surgery remains the cornerstone treatment with 5-year survival rates of approximately 12 –39%. Rates of local failure and distant metastases are high following surgical resection of locally advanced tumors. Neoadjuvant therapy (either radiation therapy, chemotherapy, or a combination) prior to surgery carries the advantage of tackling micrometastases and improving complete resection r ates. Neoadjuvant concurrent chemotherapy and radiotherapy are a favored approach with evidence for improved pathologic complete response (pCR) rates and improved survival compared ...
Source: Thoracic Surgery Clinics - October 18, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Shirley Lewis, Jelena Lukovic Source Type: research
Adjuvant Therapies for Esophageal Cancer
Esophageal cancer is the sixth most common cause of cancer mortality worldwide and is considered a major worldwide health challenge. Most patients diagnosed with esophageal cancer require extensive workup and management strategies. Multiple clinical trials have been conducted to evaluate the role of chemotherapy, chemoradiotherapy, and recently immunotherapy before or after surgery in the setting of localized esophageal cancer. Trimodality approaches, including preoperative chemoradiation followed by surgery or perioperative chemotherapy, have been widely accepted for treating localized esophageal cancer. However, the addi...
Source: Thoracic Surgery Clinics - October 18, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Ahmed Abdelhakeem, Mariela Blum Murphy Source Type: research
Barrett ’s Esophagus and Esophageal Adenocarcinoma: A Histopathological Perspective
Esophageal adenocarcinoma (EAC) is increasing in prevalence. Barrett ’s esophagus (BE) has long been recognized as the putative precursor lesion for EAC, but much is still unknown regarding its cell of origin and what molecular factors influence its neoplastic progression. Accurate pathologic assessment of BE biopsies is important for identifying patients most at r isk of progressing to EAC, whereas pathologic assessment of EAC specimens plays a major role in influencing therapeutic decision-making. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - October 18, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Roman E. Zyla, Sangeetha N. Kalimuthu Source Type: research
Esophageal Cancer Staging
Accurate staging is imperative in the management of esophageal cancer Over the years, different treatment modalities have evolved, ranging from endoscopic resection to traditional surgical resection and multimodal approaches, including the addition of chemotherapy, with or without radiation. In this article, we discuss the different stage groups, which guide the clinician in determining staging for esophageal cancer, and subsequent guidance in appropriate treatment modalities for each patient. These groups are based on tumor, node, and metastasis (TNM) staging and have recently been refined into clinical TNM pathologic TNM...
Source: Thoracic Surgery Clinics - October 18, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Gad Marom Source Type: research
Lymph Node Dissection for Esophageal Squamous Cell Carcinoma
Lymph node metastasis is one of the most important prognostic factors in esophageal squamous cell carcinoma. However, the optimal extent of lymph node dissection is still under debate. We specifically address several controversies regarding lymph node dissection, for example, recurrent laryngeal node lymphadenectomy, cervical lymphadenectomy, and thoracic duct resection, in esophageal squamous cell carcinoma. We also describe new concepts in surgical anatomy of the upper mediastinum and technologies, for example, near-infrared image-guided lymphatic mapping and intraoperative neural monitoring that facilitate recurrent lar...
Source: Thoracic Surgery Clinics - October 18, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Po-Kuei Hsu, Yi-Ying Lee, Lin-Chi Chuang, Yu-Chung Wu Source Type: research
Immune Checkpoint Blockade and Targeted Therapies in Esophageal Cancer
This article aims to provide an overview of recent advances in immunotherapy and targeted therapy for esophageal cancer as well as summarize ongoing clinical trials and future directions. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - October 18, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Jessica Yang, Yelena Y. Janjigian Source Type: research
Ongoing Controversies in Esophageal Cancer I
Reducing perioperative morbidity and mortality following esophagectomy remains central to surgeons ’ intraoperative decision-making. There remains wide variation in the technical approaches to esophagectomy and the employment of prophylactic strategies to reduce postoperative complications. In this article, we discuss the ongoing controversies related to feeding tube placement, pyloroplasty, an d thoracic duct clipping and the evidence regarding these procedures. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - October 18, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Sidra N. Bonner, Ryan Rebernick, Elliot Wakeam Source Type: research
Ongoing Controversies in Esophageal Cancer II
The optimal management of Siewert Type II or Junction AEG II adenocarcinoma remains a point of debate. Surgical options include an extended total gastrectomy or esophagectomy. Accurately identifying the location of the esophagogastric junction (GEJ) is important as the epicenter of the lesion is defined in reference to the GEJ. Type II tumors, in the most recent iteration of the AJCC, describe these lesions as being within 1 cm cephalad and 2 cm caudal to GEJ. Accurate staging of the location and identification of nodal metastasis is vital to guide the optimal surgical approach. Endoscopy, endosonography, CT, and PET he...
Source: Thoracic Surgery Clinics - October 18, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Nicolas Devaud, Paul Carroll Source Type: research
Endoscopic Management of Esophageal Cancer
Esophageal cancer is the eighth most common malignancy worldwide with more than 600,000 new cases diagnosed annually. Although curative approaches to early-stage esophageal cancer have historically been surgical, advances in endoscopic techniques resulted in the identification of patients who may benefit from minimally invasive endoscopic therapies. In this exposition, we discuss the identification of patients who are candidates for endoscopic resection and detail different aspects of endoscopic curative techniques for esophageal neoplasia. We also discuss therapies directed at the palliation of esophageal cancer sequelae....
Source: Thoracic Surgery Clinics - October 18, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Akira Dobashi, Darrick K. Li, Georgios Mavrogenis, Kavel H. Visrodia, Fateh Bazerbachi Source Type: research
Colon Interposition for Esophageal Cancer
Esophagectomy and colon interposition in the adult patient, either for primary alimentary reconstruction or as a secondary replacement after initial resection/reconstruction for malignant or benign disease, remains a valuable tool in the thoracic surgeon ’s armamentarium. It is important for surgeons to remain versed in the complexities of the operation, including preoperative preparation and decision making, operative procedural and technical variations, and recognition and timely treatment of postoperative complications. In this article, we pres ent technical details of the procedure, a review of selected published stu...
Source: Thoracic Surgery Clinics - October 18, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Manuel Villa Sanchez, Evan T. Alicuben, James D. Luketich, Inderpal S. Sarkaria Source Type: research
Supercharged Jejunal Interposition
Complex esophageal reconstruction represents a high risk and challenging procedure. A dedicated pathway with multispecialty teams can facilitate a systematic checklist approach to perioperative management and evaluation of long-term outcomes. Refinements in the operative technique for supercharged pedicled jejunum (SPJ) for long segment interposition in esophageal reconstruction are reviewed in this article. Medical and surgical complications among this complex niche group of patients are significant and require care in specialist centers with a focused team. Patient-reported outcomes (PROs) in long-segment SPJ interpositi...
Source: Thoracic Surgery Clinics - October 18, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Anita T. Mohan, Samir Mardini, Shanda H. Blackmon Source Type: research
Overview of the Management of Esophageal Cancer
Esophageal cancer surgery is an exciting, but challenging, part of thoracic surgery practice. The management of esophageal cancer requires thoughtful preoperative planning, technical oncologic resection, creativity in reconstruction, and meticulous postoperative care. It is also multidisciplinary, involving expertise from therapeutic endoscopists, medical and radiation oncologists, radiologists, and pathologists. Despite this, the thoracic surgeon maintains a central role for every patient from diagnosis to palliation. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - October 18, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Jonathan C. Yeung, Elena Elimova Tags: Preface Source Type: research
Esophageal Cancer Management: Baby Steps Distally
Globally, esophageal cancer is a dismal disease accounting for more than 544,000 deaths each year1 and with a continued increase in incidence in the United States to ∼20,000 cases per year in 2021. The best chance of cure for locally advanced disease includes an esophagectomy with a concerning morbidity rate of ∼50%. On the other hand, positive progress is happening on all multimodal fronts. Not only has there been the paradigm shift for curative management of superficial cancers with endoscopic resections but also we are seeing the advances with use of immunotherapy and targeted therapies beyond trastuzumab. (Source: ...
Source: Thoracic Surgery Clinics - October 18, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Virginia R. Litle Tags: Foreword Source Type: research
Esophageal Cancer
THORACIC SURGERY CLINICS (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - October 18, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Jonathan C. Yeung, Elena Elimova Source Type: research
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ELSEVIER (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - October 18, 2022 Category: Cardiovascular & Thoracic Surgery Source Type: research
