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Neoadjuvant chemotherapy is established in the treatment of gastric adenocarcinoma. Histopathological regression may have important prognostic implications. There are little data comparing clinical outcomes of patients with gastric adenocarcinoma that received neoadjuvant treatment and those neoadjuvant naive. The aim of this study is to determine the impact of neoadjuvant chemotherapy upon prognosis of patients being treated for gastric adenocarcinoma.Consecutive patients with gastric cancer from a single center between 2007 and 2017 were evaluated. Patients were treated with either a subtotal or total gastrectomy with D2 lymphadenectomy. Stage-by-stage comparison of the extent of pathological downstaging was conducted for patients who received neoadjuvant treatment (ypTNM) and those who did not (pTNM) using the TNM eighth edition.Overall, 384 patients underwent gastrectomy, 141 patients received neoadjuvant chemotherapy, and 86 patients (58.1%) were downstaged. Downstaged patients had improved overall survival compared to patients who did not respond to neoadjuvant chemotherapy (not reported vs 66 months, P.001). Downstaging by3 stages was the strongest independent predictor of overall survival (hazard ratio: 0.17; 95% confidence interval 0.062-0.44). Overall survival was significantly better among patients in the ypTNM groups when a stage-by-stage comparison was performed with the pTNM group.Pathological stage is a more accurate predictor of prognosis compared clinical stage with downstaged patients benefiting from lower recurrence rates and improved overall survival. Patients downstaged due to neoadjuvant chemotherapy may potentially have more favorable clinical outcomes compared to stage-matched patients who did not receive this.

Gastric cancer has seen a considerable change in management, and outcomes for the past 30 years. Historically, the overall prognosis has been regarded as poor. However, the use of multimodal treatment, and integration of enhanced recovery pathways have improved short and long-term outcomes. The aim of this study was to evaluate the changing trends in presentation, management, and outcomes for patients undergoing surgical treatment for gastric cancers over 30 years.Data from consecutive patients undergoing gastrectomy with curative intent for gastric adenocarcinoma between 1989 and 2018 from a single-center, high-volume unit were reviewed. Presentation method, management strategies and outcomes were reviewed. Patients were grouped into successive 5-year cohorts for comparison and evaluation of changing trends.Between 1989 and 2018, 1,162 patients underwent gastrectomy with curative intent for cancer. Median age was 71 years (interquartile range, 63-76 years) and 763 (66%) were male. Patient presentation changed with epigastric discomfort now the most common presentation (67%). An improvement in overall complications from 54% to 35% (P = .006) and mortality from 8% to 1% (P.001) was seen over the time period and overall survival improved from 28 months to 53 months (P.001).Both short-term and long-term outcomes have significantly improved over the 30 years studied. The reasons for this are multifactorial and include the use of perioperative chemotherapy, the introduction of an enhanced recovery pathway, and improved preoperative assessment of patients through a multidisciplinary input.

Carcinoma of the oesophagus remains one of the most challenging conditions confronting the surgeon today. Oesophagectomy is associated with the highest mortality of any elective general surgical procedure despite advances in perioperative care. Adenocarcinomas account for over two-thirds of oesophageal cancers in the UK, and their incidence has increased dramatically in the past few decades, particularly among white males. Early detection of symptomatic patients and endoscopic surveillance of high-risk groups (such as those with Barrett’s oesophagus) is essential because outcome is strongly dependent on the stage of disease. Accurate disease staging involves endoscopy, CT, endoscopic ultrasound, but may also include bone scintigraphy, PET CT, laparoscopy or endoscopic mucosal resection. An assessment of patient fitness is equally vital in determining management strategies within a multidisciplinary setting. Resection for stage 1a and 2a tumours achieves good 5-year survival, but surgery alone provides poor cure rates for more advanced disease. Patients with node-positive disease should be considered for neo-adjuvant chemotherapy with the OE02 regimen or as part of the OE05 trial. Only 30–40% of patients are suitable for resection, predominantly due to the advanced stage at presentation but in some individuals due to co-morbidity. Palliation of symptoms in the remaining patients might involve self-expanding metal stents, chemotherapy, external beam or intraluminal radiotherapy.

Oesophageal cancer is recognized as one of the most challenging pathological conditions confronting the surgeon. Despite advances in perioperative care, oesophagectomy is still associated with the highest mortality of any routinely performed elective surgical procedure. Treatment is multidisciplinary; however, no modality other than surgery has consistently been shown to provide the opportunity of cure for this increasingly common cancer. Nevertheless, as a consequence of advanced disease and co-morbidity, only a third of patients are suitable for surgical resection while, in others, palliation of symptoms remains the aim.

Barrett's esophagus results from the long-term effects of both acid and bile reflux. After subtotal esophagectomy and reconstruction with a gastric tube, many patients experience profound reflux. Development of Barrett's epithelium in the esophageal remnant has been reported. Here we report the case of a man who was diagnosed with adenocarcinoma in his esophageal remnant on a background of Barrett's change 52 years after undergoing one of the first esophageal resections for benign disease as a child.

Background: Argon plasma coagulation is a diathermy-based non-contact therapeutic endoscopic modality that may have a lower risk of perforation than other tissue ablation techniques. Methods: Its effect was studied on three fresh esophageal and three fresh gastric resection specimens using power settings from 40 to 99 Watts at 90 degrees, with 1 mm separation using pulse durations of 1 and 3 seconds. A scoring system for depth of tissue damage was created and samples were analyzed blindly by a gastrointestinal histopathologist. Results: There was significantly greater damage to gastric tissue using a 3-second (compared with 1-second) pulse ( p = 0.003) and marginally significantly greater damage to esophageal tissue using the 3-second pulse ( p = 0.053). Tissue damage was related to power setting for gastric ( p = 0.031) but not for esophageal tissue ( p = 0.065). Only 1 of 42 esophageal samples and 2 of 42 gastric samples examined showed damage extending into the muscularis propria. Conclusions: Deep tissue damage that could lead to perforation was rare with argon plasma coagulation. The depth of gastric mucosal damage increased with increased pulse duration and increasing power settings, and, although the depth of esophageal mucosal damage was marginally related to pulse duration, it was not related to the power setting. (Gastrointest Endosc 2000;52:342–5).

Surgery has been the mainstay of treatment for spontaneous full-thickness rupture of the esophagus for the last 50 years. In an acute presentation with contamination of the mediastinal or pleural cavities, this remains the definitive course of action. However, the management when diagnosis has been delayed is more contentious. This is a description of a novel approach with a combined percutaneousendoscopic technique that was used in 2 such cases.