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Article ; Online: Facing adenocarcinoma of distal esophagus and esophagogastric junction: a CROSS versus FLOT propensity score-matched analysis of oncological outcomes in a high-volume institution.

Lombardi, Pietro Maria / Pansa, Andrea / Basato, Silvia / Giorgi, Lorenzo / Perano, Vittoria / Marano, Salvatore / Castoro, Carlo

Updates in surgery

2023 Volume 75, Issue 4, Page(s) 921–930

Abstract: Multimodality treatments are the gold standard for advanced resectable gastroesophageal cancer. Neoadjuvant CROSS and perioperative FLOT regimens are adopted for distal esophageal and esophagogastric junction adenocarcinoma (DE/EGJ AC). At present, none ... ...

Abstract	Multimodality treatments are the gold standard for advanced resectable gastroesophageal cancer. Neoadjuvant CROSS and perioperative FLOT regimens are adopted for distal esophageal and esophagogastric junction adenocarcinoma (DE/EGJ AC). At present, none of the approaches is clearly superior in the context of a curative-intent multimodal treatment. We analyzed consecutive patients treated with CROSS or FLOT and surgery for DE/EGJ AC between August 2017 and October 2021. Propensity score matching was performed to balance baseline characteristics of patients. The primary endpoint was disease-free survival. Secondary endpoints included overall survival, 90-day morbidity/mortality rates, pathological complete response, margin-negative resection, and pattern of recurrence. Of the 111 patients included, 84 were correctly matched after PSM, 42 in each group. The 2-year DFS rate was 54.2% versus 64.1% in the CROSS and FLOT group, respectively (p = 0.182). Patients in the CROSS group showed a lower number of harvested LN when compared to the FLOT group (29.5 versus 39.0 respectively, p = 0.005). A higher rate of distal nodal recurrence was found in the CROSS group (23.8% versus 4.8%, p = 0.026). Although not significant, the CROSS group showed a trend toward higher rate of isolated distant recurrence (33.3% versus 21.4% respectively, p = 0.328), together with a higher rate of early recurrence (23.8% versus 9.5% respectively, p = 0.062). FLOT and CROSS regimens for DE/EGJ AC offer similar DFS and OS, together with comparable morbidity/mortality rates. CROSS regimen was associated with a higher distant nodal recurrence rate. Results of ongoing randomized clinical trials are awaited.
MeSH term(s)	Humans ; Propensity Score ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Esophagus/pathology ; Stomach Neoplasms/surgery ; Stomach Neoplasms/drug therapy ; Esophageal Neoplasms/surgery ; Esophagogastric Junction/surgery ; Esophagogastric Junction/pathology ; Neoadjuvant Therapy ; Adenocarcinoma/surgery ; Adenocarcinoma/drug therapy
Language	English
Publishing date	2023-03-29
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-023-01497-5
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Article ; Online: Endoscopic ultrasound-guided gastro-enteric anastomosis in the COVID era: May the pandemic emphasize the benefit?

Fugazza, Alessandro / Spadaccini, Marco / Bramanti, Stefania / Castoro, Carlo / Repici, Alessandro / Anderloni, Andrea

Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver

2020 Volume 53, Issue 1, Page(s) 8–10

MeSH term(s)	Anastomosis, Surgical ; COVID-19 ; Endosonography ; Humans ; Pandemics ; SARS-CoV-2 ; Ultrasonography, Interventional
Keywords	covid19
Language	English
Publishing date	2020-10-07
Publishing country	Netherlands
Document type	Letter ; Comment
ZDB-ID	1459373-7
ISSN	1878-3562 ; 1125-8055
ISSN (online)	1878-3562
ISSN	1125-8055
DOI	10.1016/j.dld.2020.09.014
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Article ; Online: Reply to Letter to the Editor regarding “Oncological outcomes of squamous cell carcinoma of the cervical esophagus treated with definitive (chemo‐)radiotherapy: a systematic review and meta‐analysis”

De Virgilio, Armando / Costantino, Andrea / Festa, Bianca Maria / Mercante, Giuseppe / Franceschini, Davide / Franzese, Ciro / Scorsetti, Marta / Marrari, Andrea / Cavina, Raffaele / Marano, Salvatore / Castoro, Carlo / Spriano, Giuseppe

J Cancer Res Clin Oncol. 2023 Mar., v. 149, no. 3 p.1369-1371

2023

Abstract: In a previous study, we performed a meta-analysis of the oncological outcomes of patients suffering from cervical esophageal squamous cell carcinoma treated with definitive chemoradiotherapy. Further analysis was performed, and a random effect modeling ... ...

Abstract	In a previous study, we performed a meta-analysis of the oncological outcomes of patients suffering from cervical esophageal squamous cell carcinoma treated with definitive chemoradiotherapy. Further analysis was performed, and a random effect modeling showed a pooled local–regional failure rate of 41.4% (95% CI 32.2–50.8), and a pooled distant failure rate of 21.6% (95% CI 17.0–26.5). The included studies used a median radiotherapy (RT) dose of 61.2 Gy (95% CI 60.0–62.0, range 56.0–66.0), but we measured a non-significant impact of the RT dose on the pooled overall survival (OS), suggesting that an increased RT dose might not be related to an improved OS (p = 0.23). Further research should be conducted to define predictors and prognostic categories that may select the best treatment option for each patient.
Keywords	esophagus ; meta-analysis ; patients ; radiotherapy ; squamous cell carcinoma ; systematic review
Language	English
Dates of publication	2023-03
Size	p. 1369-1371.
Publishing place	Springer Berlin Heidelberg
Document type	Article ; Online
Note	Letter
ZDB-ID	134792-5
ISSN	1432-1335 ; 0171-5216 ; 0084-5353 ; 0943-9382
ISSN (online)	1432-1335
ISSN	0171-5216 ; 0084-5353 ; 0943-9382
DOI	10.1007/s00432-022-04441-z
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Article ; Online: Oncological outcomes of squamous cell carcinoma of the cervical esophagus treated with definitive (chemo-)radiotherapy: a systematic review and meta-analysis

J Cancer Res Clin Oncol. 2023 Mar., v. 149, no. 3, p. 1029-1041

2023 , Page(s) 1029–1041

Abstract: PURPOSE: To determine the oncological outcomes of cervical esophageal squamous cell carcinoma (CESCC) treated with definitive chemoradiotherapy (CRT). METHODS: A systematic review and meta-analysis was performed according to the PRISMA guidelines. ... ...

Abstract	PURPOSE: To determine the oncological outcomes of cervical esophageal squamous cell carcinoma (CESCC) treated with definitive chemoradiotherapy (CRT). METHODS: A systematic review and meta-analysis was performed according to the PRISMA guidelines. RESULTS: A total of 1222 patients (median age: 63.0 years, 95% CI 61.0–65.0) were included from 22 studies. The median follow-up time was 34.0 months (n = 1181, 95% CI 26.4–36.0). Estimated pooled OS rates (95% CI) at 1, 3, and 5 years were 77.9% (73.9–82.2), 48.4% (43.2–54.3), and 35.3% (29.7–41.9), respectively. The median OS (95% CI) was 33.4 months (25.8–42.2). Estimated pooled PFS rates (n = 595; 95% CI) at 1, 3, and 5 years were 64.1% (57.9–71.0), 38.0% (33.3–45.5), and 29.8% (23.9–37.1), respectively. The median PFS (95% CI) was 19.8 months (14.9–26.6). CONCLUSIONS: Definitive CRT is a valuable first-line treatment for the management of CESCC. Further studies should focus on survival predictors able to define stage-based clinical guidelines.
Keywords	esophagus ; meta-analysis ; radiotherapy ; squamous cell carcinoma ; systematic review
Language	English
Dates of publication	2023-03
Size	p. 1029-1041
Publishing place	Springer Berlin Heidelberg
Document type	Article ; Online
ZDB-ID	134792-5
ISSN	1432-1335 ; 0171-5216 ; 0084-5353 ; 0943-9382
ISSN (online)	1432-1335
ISSN	0171-5216 ; 0084-5353 ; 0943-9382
DOI	10.1007/s00432-022-03965-8
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Article ; Online: Gastric tube cancer after esophagectomy for cancer: a systematic review.

Gentile, Damiano / Riva, Pietro / Da Roit, Anna / Basato, Silvia / Marano, Salvatore / Castoro, Carlo

Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus

2019 Volume 32, Issue 8

Abstract: Gastric conduit used for reconstruction after esophagectomy for cancer has the potential to develop a metachronous neoplasm known as gastric tube cancer (GTC). The aim of this study was to review literature and evaluate outcomes and possible treatment ... ...

Abstract	Gastric conduit used for reconstruction after esophagectomy for cancer has the potential to develop a metachronous neoplasm known as gastric tube cancer (GTC). The aim of this study was to review literature and evaluate outcomes and possible treatment strategies for GTC. A comprehensive systematic literature search was conducted using PubMed, EMBASE, Scopus, and the Cochrane Library Central Register of Controlled Trials. No restriction was set for the type of publication, number, age, or sex of the patients. The search was limited to articles in English. Characteristics of esophageal cancer (EC) and its treatment and GTC and its treatment were analyzed. A total of 28 studies were analyzed, 12 retrospective analyses and 16 case reports, involving 229 patients with 250 GTCs in total. The majority of ECs (88.2%) were squamous cell carcinomas. In 120 patients (52.4%) a posterior mediastinal reconstructive route was used when esophagectomy was performed. The mean interval between esophagectomy and diagnosis of GTC was 55.8 months, with a median interval of 56.8 months (4-236 months). One hundred and twenty-four GTCs (49.6%) were located in the lower part of the gastric tube. One hundred and forty patients were endoscopically treated. Eighty-five patients underwent surgery. Thirty-six total gastrectomies with lymphadenectomy with colon or jejunal interposition were performed. Forty-three subtotal gastrectomies and 6 wedge resections were performed. The main reported postoperative complications were anastomotic leak, vocal cord palsy, and respiratory failure. Twenty-five patients were treated with palliative chemotherapy. Three-year survival rates were 69.3% for endoscopically treated patients, 58.8% for surgically resected patients, and 4% for patients who underwent palliative treatment. The feasibility of endoscopic resections in patients diagnosed with superficial GTC has been reported. Surgical treatment represented the preferred treatment method in operable patients with locally invasive tumor. Patients treated with conservative therapy have a scarce prognosis. The development of GTC should be taken into consideration during the extended follow-up of patients undergoing esophagectomy for cancer. Total gastrectomy plus lymphadenectomy should be considered the preferred treatment modality in operable patients with locally invasive tumor, when endoscopy is contraindicated. Long-term yearly endoscopic follow-up is recommended.
MeSH term(s)	Adult ; Aged ; Carcinoma, Squamous Cell/pathology ; Carcinoma, Squamous Cell/surgery ; Esophageal Neoplasms/pathology ; Esophageal Neoplasms/surgery ; Esophagectomy/adverse effects ; Esophagectomy/instrumentation ; Female ; Gastrectomy/methods ; Humans ; Intubation, Gastrointestinal/adverse effects ; Male ; Middle Aged ; Neoplasms, Second Primary/etiology ; Neoplasms, Second Primary/surgery ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Retrospective Studies ; Stomach Neoplasms/etiology ; Stomach Neoplasms/surgery ; Treatment Outcome
Language	English
Publishing date	2019-05-21
Publishing country	United States
Document type	Journal Article ; Systematic Review
ZDB-ID	639470-x
ISSN	1442-2050 ; 1120-8694
ISSN (online)	1442-2050
ISSN	1120-8694
DOI	10.1093/dote/doz049
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Article: Managing the Consequences of Oncological Major Surgery: A Short- and Medium-Term Skills Assessment Proposal for Patient and Caregiver through M.A.D.I.T. Methodology.

Turchi, Gian Piero / Fabbian, Alessandro / Alfieri, Rita / Da Roit, Anna / Marano, Salvatore / Mattara, Genny / Pilati, Pierluigi / Castoro, Carlo / Bassi, Davide / Dalla Riva, Marta Silvia / Orrù, Luisa / Pinto, Eleonora

Behavioral sciences (Basel, Switzerland)

2022 Volume 12, Issue 3

Abstract: The effects of cancer surgery and treatment harm patients' life and working ability: major causes of this can be intensified by the postoperative symptoms. This study, the first part of the HEAGIS project (Health and Employment after Gastrointestinal ... ...

Abstract	The effects of cancer surgery and treatment harm patients' life and working ability: major causes of this can be intensified by the postoperative symptoms. This study, the first part of the HEAGIS project (Health and Employment after Gastrointestinal Surgery), proposes a method to assess patients and caregivers' competences in dealing with postoperative course and the related needs to improve the adequate competences. In this observational study, an ad hoc structured interview was conducted with 47 patients and 15 caregivers between the third and fifteenth postoperative day. Oesophageal (38%), esophagogastric junction (13%), gastric (30%), colon (8%) and rectum (11%) cancer patients were considered. Computerized textual data analysis methodology was used to identify levels of competences. Text analysis highlighted three different levels (low, medium and high) of four specific types of patients and caregivers' competences. In particular, the overall trend of the preview of future scenarios and use of resource competences was low. Less critical were situation evaluation and preview repercussion of own actions' competences. Caregivers' trends were similar. The Kruskal-Wallis test did not distinguish any differences in the level of competences related to the characteristics of the participants. Patients and caregivers are not accurate in planning the future after surgery, using personal beliefs rather than referring to physicians, and not recognizing adequate resources. The medium-low competences' trend leads to unexpected critical situations, and patients could not deal with them in a maximally effective way. Both patients and caregivers should be taken over by healthcare professionals to improve patients' competences and make the curative surgery effective in daily life.
Language	English
Publishing date	2022-03-15
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2651997-5
ISSN	2076-328X
ISSN	2076-328X
DOI	10.3390/bs12030077
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Article: Critical Competences for the Management of Post-Operative Course in Patients with Digestive Tract Cancer: The Contribution of MADIT Methodology for a Nine-Month Longitudinal Study.

Pinto, Eleonora / Fabbian, Alessandro / Alfieri, Rita / Da Roit, Anna / Marano, Salvatore / Mattara, Genny / Pilati, Pierluigi / Castoro, Carlo / Cavarzan, Marco / Dalla Riva, Marta Silvia / Orrù, Luisa / Turchi, Gian Piero

Behavioral sciences (Basel, Switzerland)

2022 Volume 12, Issue 4

Abstract: There is a high postoperative morbidity rate after cancer surgery, that impairs patients’ self-management, job condition and economic strength. This paper describes the results of a peculiar psychological intervention on patients undergoing surgery for ... ...

Abstract	There is a high postoperative morbidity rate after cancer surgery, that impairs patients’ self-management, job condition and economic strength. This paper describes the results of a peculiar psychological intervention on patients undergoing surgery for esophageal, gastric and colorectal cancer. The intervention aimed to enhance patients’ competences in the management of postoperative daily life. A narrative approach (M.A.D.I.T.—Methodology for the Analysis of Computerised Text Data) was used to create a questionnaire, Health and Employment after Gastro-Intestinal Surgery—Dialogical Questionnaire, HEAGIS-DQ, that assesses four competences. It was administered to 48 participants. Results were used as guidance for specific intervention, structured on patients’ competence profiles. The intervention lasted nine months after surgery and was structured in weekly to monthly therapeutic sessions. Quality of Life questionnaires were administered too. At the end of the intervention, 94% of patients maintained their job and only 10% of patients asked for financial support. The mean self-perception of health-related quality of life was 71.2. The distribution of three of four competences increased after nine months (p < 0.05). Despite economic difficulties due to lasting symptoms after surgery, and to the current pandemic scenario, a structured intervention with patients let them to resume their jobs and continue activities after surgery.
Language	English
Publishing date	2022-04-09
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2651997-5
ISSN	2076-328X
ISSN	2076-328X
DOI	10.3390/bs12040101
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Article ; Online: Oncological outcomes of cervical esophageal cancer treated primarily with surgery: a systematic review and meta-analysis.

European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery

2022

Abstract: Purpose: To determine the oncological outcomes of cervical esophageal cancer (CEC) treated primarily with surgery.: Methods: A systematic review and meta-analysis was performed according to the PRISMA guidelines.: Results: A total of 868 patients ... ...

Abstract	Purpose: To determine the oncological outcomes of cervical esophageal cancer (CEC) treated primarily with surgery. Methods: A systematic review and meta-analysis was performed according to the PRISMA guidelines. Results: A total of 868 patients were included from 18 studies. Estimated pooled Overall Survival (OS) rates (95% Confidence Interval, CI) at 1 and 5 years were 74.4% (66.5-83.3), and 26.6% (20.3-34.7), respectively. Larynx non-preserving surgery (n = 229) showed an estimated pooled OS rates (95% CI) at 1 and 5 years of 59.3% (51.5-68.2) and 14.6% (8.8-24.3), respectively. On the other hand, larynx preserving surgery (n = 213) showed an estimated pooled OS rates (95% CI) at 1 and 5 years of 83.6% (78.2-89.4) and 35.1% (24.9-49.6), respectively. Conclusions: Primary larynx-preserving surgery remains a valuable option for the management of CEC, with similar survival outcomes compared to primary chemoradiotherapy (CRT). On the other hand, larynx non-preserving surgery showed a significantly reduced survival, that may reflect the more advanced T classification of these tumors. Further studies are mandatory to directly compare primary surgery and primary CRT, distinguishing larynx preserving and non-preserving surgery.
Language	English
Publishing date	2022-08-15
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1017359-6
ISSN	1434-4726 ; 0937-4477
ISSN (online)	1434-4726
ISSN	0937-4477
DOI	10.1007/s00405-022-07589-z
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Article ; Online: Oncological outcomes of squamous cell carcinoma of the cervical esophagus treated with definitive (chemo-)radiotherapy: a systematic review and meta-analysis.

Journal of cancer research and clinical oncology

2022 Volume 149, Issue 3, Page(s) 1029–1041

Abstract: Purpose: To determine the oncological outcomes of cervical esophageal squamous cell carcinoma (CESCC) treated with definitive chemoradiotherapy (CRT).: Methods: A systematic review and meta-analysis was performed according to the PRISMA guidelines.!## ...

Abstract	Purpose: To determine the oncological outcomes of cervical esophageal squamous cell carcinoma (CESCC) treated with definitive chemoradiotherapy (CRT). Methods: A systematic review and meta-analysis was performed according to the PRISMA guidelines. Results: A total of 1222 patients (median age: 63.0 years, 95% CI 61.0-65.0) were included from 22 studies. The median follow-up time was 34.0 months (n = 1181, 95% CI 26.4-36.0). Estimated pooled OS rates (95% CI) at 1, 3, and 5 years were 77.9% (73.9-82.2), 48.4% (43.2-54.3), and 35.3% (29.7-41.9), respectively. The median OS (95% CI) was 33.4 months (25.8-42.2). Estimated pooled PFS rates (n = 595; 95% CI) at 1, 3, and 5 years were 64.1% (57.9-71.0), 38.0% (33.3-45.5), and 29.8% (23.9-37.1), respectively. The median PFS (95% CI) was 19.8 months (14.9-26.6). Conclusions: Definitive CRT is a valuable first-line treatment for the management of CESCC. Further studies should focus on survival predictors able to define stage-based clinical guidelines.
MeSH term(s)	Humans ; Middle Aged ; Esophageal Squamous Cell Carcinoma/pathology ; Esophageal Neoplasms/pathology ; Retrospective Studies ; Carcinoma, Squamous Cell/drug therapy ; Chemoradiotherapy
Language	English
Publishing date	2022-03-02
Publishing country	Germany
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	134792-5
ISSN	1432-1335 ; 0171-5216 ; 0084-5353 ; 0943-9382
ISSN (online)	1432-1335
ISSN	0171-5216 ; 0084-5353 ; 0943-9382
DOI	10.1007/s00432-022-03965-8
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Article ; Online: Reply to Letter to the Editor regarding "Oncological outcomes of squamous cell carcinoma of the cervical esophagus treated with definitive (chemo-)radiotherapy: a systematic review and meta-analysis".

Journal of cancer research and clinical oncology

2022 Volume 149, Issue 3, Page(s) 1369–1371

Abstract	In a previous study, we performed a meta-analysis of the oncological outcomes of patients suffering from cervical esophageal squamous cell carcinoma treated with definitive chemoradiotherapy. Further analysis was performed, and a random effect modeling showed a pooled local-regional failure rate of 41.4% (95% CI 32.2-50.8), and a pooled distant failure rate of 21.6% (95% CI 17.0-26.5). The included studies used a median radiotherapy (RT) dose of 61.2 Gy (95% CI 60.0-62.0, range 56.0-66.0), but we measured a non-significant impact of the RT dose on the pooled overall survival (OS), suggesting that an increased RT dose might not be related to an improved OS (p = 0.23). Further research should be conducted to define predictors and prognostic categories that may select the best treatment option for each patient.
MeSH term(s)	Humans ; Esophageal Squamous Cell Carcinoma/pathology ; Esophageal Neoplasms/pathology ; Carcinoma, Squamous Cell/pathology ; Prognosis ; Chemoradiotherapy
Language	English
Publishing date	2022-10-29
Publishing country	Germany
Document type	Meta-Analysis ; Systematic Review ; Letter
ZDB-ID	134792-5
ISSN	1432-1335 ; 0171-5216 ; 0084-5353 ; 0943-9382
ISSN (online)	1432-1335
ISSN	0171-5216 ; 0084-5353 ; 0943-9382
DOI	10.1007/s00432-022-04441-z
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