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Surgical Treatment of Gastrointestinal Cancers

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (18 October 2022) | Viewed by 26816

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Prof. Dr. Ulrich Ronellenfitsch

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Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Halle (Saale), Germany
Interests: upper gastrointestinal cancer; multimodal treatment; gastrectomy; esophagectomy; sarcoma; quality of care; meta-analysis
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Special Issue Information

Dear Colleagues,

Even though there have been remarkable advances in systemic therapy of gastrointestinal malignancies over the last few decades, surgery remains the sole therapeutic approach offering a chance for a definite cure in numerous instances. Moreover, non-curative operations are part of the treatment algorithm of many patients with gastrointestinal cancer with the aim of alleviating symptoms and improving quality of life. In order to achieve the best outcomes, taking an evidence-based decision for or against an operation at the right time in the treatment sequence is crucial. The surgeon must pick the most appropriate surgical approach for the specific patient and disease from an ever-growing choice of available techniques. Laparoscopy and robotic resections have gained popularity among both patients and surgeons. While the former can now be considered a standard approach in many scenarios, the latter shows promising outcomes but still lacks a broad foundation of high-quality evidence. For all oncological operations, perioperative treatment plays a crucial role in achieving the desired outcomes, though it needs to be adapted to the characteristics of both the operation and the patient. Possible postoperative complications need to be avoided or, if this is not possible, detected early and treated in a timely and appropriate manner in order to avoid or at least mitigate long-lasting or permanent sequelae for the patient.

For this Special Issue of Cancers, I invite you to submit up-to-date original research, short communications, meta-analyses, and comprehensive narrative review articles on all aspects of surgical treatment of gastrointestinal cancers. Moreover, the results of preclinical studies with implications on surgical treatment also qualify for publication.

Prof. Dr. Ulrich Ronellenfitsch
Guest Editor

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

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Keywords

gastrointestinal cancer
surgery
surgical technique
perioperative treatment

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Published Papers (11 papers)

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Editorial

Jump to: Research, Other

3 pages, 192 KiB

Open AccessEditorial

Surgical Treatment of Gastrointestinal Cancers

by Ulrich Ronellenfitsch

Cancers 2023, 15(14), 3743; https://doi.org/10.3390/cancers15143743 - 24 Jul 2023

Cited by 1 | Viewed by 1302

Abstract

Even though there have been remarkable advances in systemic treatment of gastrointestinal malignancies over the last few decades, in the vast majority of instances, surgery remains the sole therapeutic approach offering a chance for a definite cure [...] Full article

(This article belongs to the Special Issue Surgical Treatment of Gastrointestinal Cancers)

Research

Jump to: Editorial, Other

9 pages, 522 KiB

Open AccessArticle

Short and Long-Term Surgical Outcomes of Laparoscopic Total Gastrectomy Compared with Open Total Gastrectomy in Gastric Cancer Patients

by Sang Soo Eom, Sin Hye Park, Bang Wool Eom, Hong Man Yoon, Young-Woo Kim and Keun Won Ryu

Cancers 2023, 15(1), 76; https://doi.org/10.3390/cancers15010076 - 23 Dec 2022

Cited by 5 | Viewed by 1828

Abstract

This study aimed to compare the efficacy of laparoscopic total gastrectomy (LTG) with that of open total gastrectomy (OTG) in terms of postoperative complications and long-term survival. We retrospectively reviewed the clinicopathological data of 560 patients, who underwent total gastrectomy between 2012 and 2016 at the National Cancer Center, Korea. Propensity-score matching (PSM) was performed to correct for discrepancies between the two groups. Matched variables included sex, age, body mass index, American Society of Anesthesiologists score, and pathological Tumor–Node–Metastasis stage. After PSM, 238 patients were included in this analysis. The rate of D2 lymph node dissection was significantly higher in the OTG group than in the LTG group. The estimated blood loss was significantly lower in the LTG group than in the OTG group. The overall complication rate was not significantly different between the two groups. There was no significant difference in the 3-year disease-free and 5-year overall survival rates between the two groups. LTG and OTG had comparable efficacies in gastric cancer patients regarding short- and long-term surgical outcomes. This study suggests that LTG could be an alternative approach to the OTG. Full article

(This article belongs to the Special Issue Surgical Treatment of Gastrointestinal Cancers)

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6 pages, 227 KiB

Open AccessCommunication

The Use of Mechanical Bowel Preparation and Oral Antibiotic Prophylaxis in Elective Colorectal Surgery: A Call for Change in Practice

by Nikoletta A. Petrou and Christos Kontovounisios

Cancers 2022, 14(23), 5990; https://doi.org/10.3390/cancers14235990 - 4 Dec 2022

Cited by 4 | Viewed by 2876

Abstract

Elective colorectal surgery is associated with one of the highest rates of surgical site infections (SSIs), which result in prolonged length of stay, morbidity, and mortality for these patients and have a significant financial burden to healthcare systems. In an effort to reduce the frequency of SSI rates associated with colorectal surgery, the 2018 World Health Organisation (WHO) guidelines recommend the routine use of mechanical bowel preparation (MBP) and oral antibiotic prophylaxis (OAP) in adult patients undergoing elective colorectal surgery. However, this recommendation remains a topic of debate internationally. The National Institute of Clinical Excellence (NICE) guidelines, last revised in 2019, recommend against the routine use of MBP and do not address the issue of OAP. In this communication, we reviewed the current guidelines and examined the most recent evidence from randomised-control trials (RCTs) and meta-analyses on the effect of MBP and OAP on SSI rates since the 2019 NICE guideline review. This recent evidence clearly demonstrated an SSI-risk-reduction benefit with the additional use of OAP and the combination of MBP and OAP in this group of patients, and we therefore highlight the need for change of the current NICE guidelines. Full article

(This article belongs to the Special Issue Surgical Treatment of Gastrointestinal Cancers)

16 pages, 279 KiB

Open AccessCommunication

Colorectal Cancer and the Obese Patient: A Call for Guidelines

by Nikoletta A. Petrou, Henna Rafique, Shahnawaz Rasheed, Paris Tekkis and Christos Kontovounisios

Cancers 2022, 14(21), 5255; https://doi.org/10.3390/cancers14215255 - 26 Oct 2022

Cited by 4 | Viewed by 2617

Abstract

The link between obesity and colorectal cancer has been well established. The worldwide rise in obesity rates in the past 40 years means that we are dealing with increasing numbers of obese patients with colorectal cancer. We aimed to review the existing guidelines and make recommendations specific to this group of patients. Upon comparing the current NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ®), the guidelines from the European Society of Medical Oncology (ESMO) and the guidelines of the Japanese Society for Cancer of the Colon and Rectum (JSCCR), we observed that these did not take into consideration the needs of obese patients. We proceeded to make specific recommendations with regards to the diagnostic work-up, surgical pathways, minimally invasive technique, perioperative treatment, post-operative surveillance, and management of metastatic disease in this group of patients. Our review highlights the need for modification of the existing guidelines to account for the needs of this patient cohort. A multidisciplinary approach, including principles used by bariatric surgeons, should be the way forward to reach consensus in the management of this group of patients. Full article

(This article belongs to the Special Issue Surgical Treatment of Gastrointestinal Cancers)

13 pages, 1331 KiB

Open AccessArticle

Neoadjuvant Chemotherapy-Chemoradiation for Borderline-Resectable Pancreatic Adenocarcinoma: A UK Tertiary Surgical Oncology Centre Series

by Rachna Gorbudhun, Pranav H. Patel, Eve Hopping, Joseph Doyle, Georgios Geropoulos, Vasileios K. Mavroeidis, Sacheen Kumar and Ricky H. Bhogal

Cancers 2022, 14(19), 4678; https://doi.org/10.3390/cancers14194678 - 26 Sep 2022

Cited by 5 | Viewed by 1618

Abstract

Background: Patients with borderline-resectable pancreatic ductal adenocarcinoma (BR-PDAC) have historically poor survival, even after curative pancreatic resection and adjuvant chemotherapy. Emerging evidence suggests that neoadjuvant chemoradiation (NCR) improves R0 resection rates in BR-PDAC patients. We evaluated the R0 resection rate, disease-free survival (DFS) and overall survival (OS) in our patients who underwent NCR for BR-PDAC at our institution. Methods: All patients who underwent NCR for BR-PDAC from January 2010 to March 2020 were included in the study. The patients received a variety of NCR regimens during the study period, and in patients with radiological evidence of tumour stability or regression, pancreatic resection was performed. The primary endpoint was the OS, and the secondary endpoints included patient morbidity, the R0 resection rate, histological parameters and the DFS. Results: The study included 29 patients (16 men and 13 women), with a median age of 65 years (range 46–74 years). Of these 29 patients, 17 received FOLFIRINOX and 12 received gemcitabine (GEM)-based NCR regimens. All patients received chemoradiation at the end of chemotherapy (range 45–56 Gy). R0 resection was achieved in 75% of the patients, with a higher rate noted in the FOLFIRINOX group. The median DFS was 22 months for the whole cohort but higher in the FOLFIRINOX group (34 months). The median OS for the cohort was 29 months, with a higher median OS noted for the FOLFIRINOX cohort versus the GEM cohort (42 versus 28 months). Conclusion: NCR, particularly FOLFIRINOX-based treatment, for BR-PDAC results in higher rates of R0 resection and an increased median DFS and OS, supporting its continued use in this patient group. Full article

(This article belongs to the Special Issue Surgical Treatment of Gastrointestinal Cancers)

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10 pages, 1495 KiB

Open AccessArticle

The Evaluation of the 1318 nm Diode Laser in Open Liver Surgery

by Patrick Pfitzmaier, Matthias Schwarzbach and Ulrich Ronellenfitsch

Cancers 2022, 14(5), 1191; https://doi.org/10.3390/cancers14051191 - 25 Feb 2022

Cited by 1 | Viewed by 1618

Abstract

(1) Background: Numerous dissection instruments are available for liver resection. So far, there has been no evidence in favor of a specific dissection device effecting a reduction in postoperative mortality and morbidity or a reduction in intraoperative blood loss. The aim of the study was to evaluate the safety of liver resection with the 1318 nm surgical laser. (2) Methods: 151 consecutive patients who underwent liver resection using the 1318 nm surgical laser (n = 119) or conventional dissection methods (n = 32) were evaluated retrospectively. As primary outcome, postoperative complications were assessed using the Clavien–Dindo classification. Secondary outcomes were postoperative mortality, reoperations and reinterventions, intraoperative blood loss, the need for vascular control using the Pringle maneuver and oncological safety assessed through histopathological evaluation of resection margins. (3) Results: For liver resections using the 1318 nm surgical laser, the postoperative morbidity (41.2% vs. 59.4%, p = 0.066), mortality (1.7% vs. 3.1%, p = 0.513) and the reoperation rate (2.5% vs. 3.1%, p = 1.000) were not significantly different from conventional liver resections. In the laser group, a lower reintervention rate (9.2% vs. 21.9%, p = 0.050) was observed. The oncological safety demonstrated by a tumor-free resection margin was similar after laser and conventional resection (93.2% vs. 89.3%, p = 0.256). The median intraoperative blood loss was significantly lower in the laser group (300 mL vs. 500 mL, p = 0.005) and there was a significantly lower need for a Pringle maneuver (3.4% vs. 15.6%, p = 0.021). (4) Conclusions: Liver resections using the 1318 nm surgical laser can be routinely performed with a favorable risk profile. Compared to alternative resection methods, they are associated with low blood loss, appear adequate from an oncological point of view, and are not associated with increased mortality and morbidity. Full article

(This article belongs to the Special Issue Surgical Treatment of Gastrointestinal Cancers)

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14 pages, 8548 KiB

Open AccessArticle

Intra- and Extrathoracic Malignant Tracheoesophageal Fistula—A Differentiated Reconstructive Algorithm

by Thomas Kremer, Emre Gazyakan, Joachim T. Maurer, Katja Ott, Andreas Gerken, Marc Schmittner, Ulrich Ronellenfitsch, Ulrich Kneser and Kai Nowak

Cancers 2021, 13(17), 4329; https://doi.org/10.3390/cancers13174329 - 27 Aug 2021

Cited by 6 | Viewed by 2123

Abstract

Background: Tracheoesophageal fistulae (TEF) after oncologic resections and multimodal treatment are life-threatening and surgically challenging. Radiation and prior procedures hamper wound healing and lead to high complication rates. We present an interdisciplinary algorithm for the treatment of TEF derived from the therapy of consecutive patients. Patients and methods: 18 patients (3 females, 15 males) treated for TEF from January 2015 to July 2017 were included. Two patients were treated palliatively, whereas reconstructions were attempted in 16 cases undergoing 24 procedures. Discontinuity resection and secondary gastric pull-up were performed in two patients. Pedicled reconstructions were pectoralis major (n = 2), sternocleidomastoid muscle (n = 2), latissimus dorsi (n = 1) or intercostal muscle (ICM, n = 7) flaps. Free flaps were anterolateral thigh (ALT, n = 4), combined anterolateral thigh/anteromedial thigh (ALT/AMT, n = 1), jejunum (n = 3) or combined ALT–jejunum flaps (n = 2). Results: Regarding all 18 patients, 11 of 16 reconstructive attempts were primarily successful (61%), whereas long-term success after multiple procedures was possible in 83% (n = 15). The 30-day survival was 89%. Derived from the experience, patients were divided into three subgroups (extrathoracic, cervicothoracic, intrathroracic TEF) and a treatment algorithm was developed. Primary reconstructions for extra- and cervicothoracic TEF were pedicled flaps, whereas free flaps were used in recurrent or persistent cases. Pedicled ICM flaps were mostly used for intrathoracic TEF. Conclusion: TEF after multimodal tumor treatment require concerted interdisciplinary efforts for successful reconstruction. We describe a differentiated reconstructive approach including multiple reconstructive techniques from pedicled to chimeric ALT/jejunum flaps. Hereby, successful reconstructions are mostly possible. However, disease and patient-specific morbidity has to be anticipated and requires further interdisciplinary management. Full article

(This article belongs to the Special Issue Surgical Treatment of Gastrointestinal Cancers)

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10 pages, 248 KiB

Open AccessArticle

Survival and Disease Recurrence in Patients with Duodenal Neuroendocrine Tumours—A Single Centre Cohort

by Oddry Folkestad, Hans H. Wasmuth, Patricia Mjønes, Reidun Fougner, Øyvind Hauso and Reidar Fossmark

Cancers 2021, 13(16), 3985; https://doi.org/10.3390/cancers13163985 - 6 Aug 2021

Cited by 7 | Viewed by 3719

Abstract

Background: Duodenal neuroendocrine tumours (D-NETs) are rare but increasingly diagnosed. This study aimed to assess the overall survival and recurrence rate among patients treated for D-NETs. Methods: Patients with D-NETs were retrospectively reviewed with a median follow-up time of 4.8 years (range 0.0–17.2 years). Results: A total of 32 patients with median age 68.0 years were identified. Fifteen patients underwent surgery while ten patients underwent endoscopic treatment. Mean estimated overall survival for the entire population was 12.1 years (95% CI 9.5–14.7 years), while 5-year overall survival was 81.3%. Tumour grade G1 was associated with longer mean estimated survival compared to G2 tumours (13.2 years versus 4.4 years, p = 0.010). None of the 23 patients who underwent presumed radical endoscopic or surgical resection had disease recurrence during follow-up. Tumours <10 mm could be treated endoscopically whereas a high proportion of patients with tumours 10–20 mm should be considered for surgery. Conclusion: Patients with D-NETs had long overall survival, and mortality was more influenced by other diseases. Both endoscopic and surgical resections were effective as no recurrences were diagnosed during follow-up. Full article

(This article belongs to the Special Issue Surgical Treatment of Gastrointestinal Cancers)

15 pages, 522 KiB

Open AccessArticle

Video-Laparoscopic versus Open Surgery in Obese Patients with Colorectal Cancer: A Propensity Score Matching Study

by Cinzia Bizzoca, Roberta Zupo, Fabrizio Aquilino, Fabio Castellana, Felicia Fiore, Rodolfo Sardone and Leonardo Vincenti

Cancers 2021, 13(8), 1844; https://doi.org/10.3390/cancers13081844 - 13 Apr 2021

Cited by 8 | Viewed by 2656

Abstract

Background: Minimally invasive surgery in obese patients is still challenging, so exploring one more item in this research field ranks among the main goals of this research. We aimed to compare short-term postoperative outcomes of open and video-laparoscopic (VL) approaches in CRC obese patients undergoing colorectal resection. Methods: We performed a retrospective analysis of a surgical database including 138 patients diagnosed with CRC, undergoing VL (n = 87, 63%) and open (n = 51, 37%) colorectal surgery. As a first step, propensity score matching was performed to balance the comparison between the two intervention groups (VL and open) in order to avoid selection bias. The matched sample (N = 98) was used to run further regression models in order to analyze the observed VL surgery advantages in terms of postoperative outcome, focusing on hospitalization and severity of postoperative complications, according to the Clavien–Dindo classification. Results: The study sample was predominantly male (N = 86, 62.3%), and VL was more frequent than open surgery (63% versus 37%). The two subgroup results obtained before and after the propensity score matching showed comparable findings for age, gender, BMI, and tumor staging. The specimen length and postoperative time before discharge were longer in open surgery (OS) patients; the number of harvested lymph nodes was higher than in VL patients as well (p < 0.01). Linear regression models applied separately on the outcomes of interest showed that VL-treated patients had a shorter hospital stay by almost two days and about one point less Clavien–Dindo severity than OS patients on average, given the same exposure to confounding variables. Tumor staging was not found to have a significant role in influencing the short-term outcomes investigated. Conclusion: Comparing open and VL surgery, improved postoperative outcomes were observed for VL surgery in obese patients after surgical resection for CRC. Both postoperative recovery time and Clavien–Dindo severity were better with VL surgery. Full article

(This article belongs to the Special Issue Surgical Treatment of Gastrointestinal Cancers)

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Other

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14 pages, 872 KiB

Open AccessSystematic Review

Management and Outcomes in Anal Canal Adenocarcinomas—A Systematic Review

by Vasilis Taliadoros, Henna Rafique, Shahnawaz Rasheed, Paris Tekkis and Christos Kontovounisios

Cancers 2022, 14(15), 3738; https://doi.org/10.3390/cancers14153738 - 31 Jul 2022

Cited by 6 | Viewed by 2249

Abstract

(1) Background: Anal canal adenocarcinomas constitute 1% of all gastrointestinal tract cancers. There is a current lack of consensus and NICE guidelines in the United Kingdom regarding the management of this disease. The overall objective was to perform a systematic review on the multitude of practice and subsequent outcomes in this group. (2) Methods: The MEDLINE, EMBASE, EMCARE and CINAHL databases were interrogated between 2011 to 2021. PRISMA guidelines were used to select relevant studies. The primary outcome measure was 5-year overall survival (OS). Secondary outcome measures included both local recurrences (LR) and distant metastases (DM). The Newcastle–Ottawa Scale (NOS) was used to assess the quality of studies retrieved. The study was registered on PROSPERO (338286). (3) Results: Fifteen studies were included. Overall, there were 11,967 participants who were demographically matched. There were 2090 subjects in the largest study and five subjects in the smallest study. Treatment modalities varied from neoadjuvant chemoradiotherapy (CRT), CRT and surgery (CRT + S), surgery then CRT (S + CRT) and surgery only (S). Five-year OS ranged from 30.2% to 91% across the literature. LR rates ranged from 22% to 29%; DM ranged from 6% to 60%. Study heterogeneity precluded meta-analysis. (4) Conclusions: Trimodality treatment with neoadjuvant chemoradiotherapy (CRT) followed by radical surgery of abdominoperineal excision of rectum (APER) appeared to be the most effective approach, giving the best survival outcomes according to the current data. Full article

(This article belongs to the Special Issue Surgical Treatment of Gastrointestinal Cancers)

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13 pages, 544 KiB

Open AccessSystematic Review

Long-Term Outcomes of Surgical Resection of Pathologically Confirmed Isolated Para-Aortic Lymph Node Metastases in Colorectal Cancer: A Systematic Review

by Maurizio Zizzo, Maria Pia Federica Dorma, Magda Zanelli, Francesca Sanguedolce, Maria Chiara Bassi, Andrea Palicelli, Stefano Ascani and Alessandro Giunta

Cancers 2022, 14(3), 661; https://doi.org/10.3390/cancers14030661 - 28 Jan 2022

Cited by 12 | Viewed by 2614

Abstract

Background: Para-aortic lymph node (PALN) metastases represent patterns of initial recurrence in only 2–6% CRC patients, after an estimated 23–28 month time interval. An increasing trend towards curative surgery has been witnessed in patients presenting with controlled PALN recurrence. Nevertheless, lack of consensus has impaired an unambiguous statement for PALN recurrence resection. Methods: We performed a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines, which led us to gain deeper insight into the prognostic factors and long-term outcomes after resection for synchronous or metachronous pathologically confirmed CRC isolated para-aortic lymph node metastases (PALNM). Pubmed/MEDLINE, Embase, Scopus, Cochrane Library and Web of Science databases were used to search all related literature. Results: The nine articles included covered a study period of 30 years (1988–2018), with a total of 161 patients. At presentation, most primary CRCs were located in the colon (74%) and 95.6%, 87.1% and 76.9% patients had T3–T4, N1–N2 and well/moderately differentiated CRC, respectively. We identified a 59.4–68% 3-year OS rate and 53.4–87.5% 5-year OS rate, with a 25–84 months median OS, 26.3–61% 3-year DFS rate and 0–60.5% 5-year DFS rate, with a 14–24 month median DFS. Overall, 62.1% re-recurrence rate ranged from 43.8% to 100%. Conclusions: Although PALNMs resection in CRC patients may be considered a feasible and beneficial option, no conclusions or recommendations can be made taking into account the current evidence. Therefore, further randomized, possibly multicenter trials are strongly recommended and mandatory if we want to have our results confirmed and patient selection criteria clearly identified. Full article

(This article belongs to the Special Issue Surgical Treatment of Gastrointestinal Cancers)

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