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Background: There is currently a lack of evidence-based guidelines regarding surveillance for recurrence after esophageal and gastric (OG) cancer surgical resection, and which symptoms should prompt endoscopic or radiological investigations for recurrence. The aim of this study was to develop a core symptom set using a modified Delphi consensus process that should guide clinicians to carry out investigations to look for suspected recurrent OG cancer in previously asymptomatic patients. Methods: A web-based survey of 42 questions was sent to surgeons performing OG cancer resections at high volume centers. The first section evaluated the structure of follow-up and the second, determinants of follow-up. Two rounds of a modified Delphi consensus process and a further consensus workshop were used to determine symptoms warranting further investigations. Symptoms with a 75% consensus agreement as suggestive of recurrent cancer were included in the core symptom set. Results: 27 surgeons completed the questionnaires. A total of 70.3% of centers reported standardized surveillance protocols, whereas 3.7% of surgeons did not undertake any surveillance in asymptomatic patients after OG cancer resection. In asymptomatic patients, 40.1% and 25.9% of centers performed routine imaging and endoscopy, respectively. The core set that reached consensus, consisted of eight symptoms that warranted further investigations included; dysphagia to solid food, dysphagia to liquids, vomiting, abdominal pain, chest pain, regurgitation of foods, unexpected weight loss and progressive hoarseness of voice. Conclusion: There is global variation in monitoring patients after OG cancer resection. Eight symptoms were identified by the consensus process as important in prompting radiological or endoscopic investigation for suspected recurrent malignancy. Further randomized controlled trials are necessary to link surveillance strategies to survival outcomes and evaluate prognostic value. [ABSTRACT FROM AUTHOR]

Background: Platelet to lymphocyte ratio (PLR) is associated with survival in oesophageal cancer. We explored whether PLR changes during different stages of treatment correlate with survival outcomes. Methods: A retrospective single-centre study was performed. Consecutive patients who received neoadjuvant chemotherapy followed by surgery for oesophageal adenocarcinoma were identified. Changes in PLR were calculated during two time periods: the first spanning the neoadjuvant period (T1); the second the perioperative period (T2). Differences in PLR were calculated for clinicopathological variables during both T1 and T2 and for variables with regards to their association with median overall survival (OS). Variables found to be significant on univariate analysis were included in a multivariate Cox regression model. Using ROC analysis, optimal cut-offs for PLR changes were identified and plotted on a Kaplan-Meir curve. Results: Of the 370 patients identified, 110 (29.7%) were included in the analysis. During T1 a positive correlation was noted between higher positive lymph node ratio and PLR change. During T2, PLR change was positively higher in patients who suffered major postoperative complications. Median survival for the cohort as a whole was 42.3 months and 5-year OS was 57.3%. Survival at 5 years was associated with lower PLR changes during T2. On univaraite analysis, median OS was significantly less for patients with a tumour size > 3 cm, poor differentiation and change in PLR ≥ 43.4 during T2. The latter two variables remained significant on multivariate analysis. Using the same PLR threshold, the survival curve comparing changes in PLR during T2 remained statistically significant. Conclusion: Perioperative PLR changes are highly prognostic of survival outcomes in patients treated for oesophageal adenocarcinoma. [ABSTRACT FROM AUTHOR]

The majority of patients with cancer undergo at least one surgical procedure as part of their treatment. Severe postsurgical infection is associated with adverse oncologic outcomes; however, the mechanisms underlying [...]

Background: Emerging data suggest asymptomatic gastrointestinal stromal tumours (GISTs) of the upper gastrointestinal (UGI) tract are not uncommon. We sought to determine their incidence in patients undergoing resection for UGI neoplasms and their impact on surgical and adjuvant treatment. Methods: We accessed a database prospectively listing all patients undergoing resection of non-GIST neoplasms of the stomach and esophagus at a single university centre over a 4.5-year period and reviewed pathology reports for the presence of synchronous GISTs in the UGI tract. We compared patient demographic and tumour characteristics, operative procedures and postoperative outcomes. Results: In all, 207 patients undergoing gastrectomy or esophagectomy for nonGIST neoplasms were included. We identified 15 synchronous GISTs in the UGI tract of 11 (5.3%) patients (1 preoperatively, 4 intraoperatively and 10 on final pathology), with an average age of 67 years. Most patients were men. Additional resections were required for GISTs identified pre- or intraoperatively. Final pathology revealed completely resected c-kit positive tumours of an average size of 0.5 (range 0.1-4.0) cm with low or very low risk of malignant potential. No patients received adjuvant therapy for the GISTs. After a median follow-up of 11 (range 2-36) months, 5 patients died from their primary cancer, 3 were alive with primary cancer recurrence, and 3 were alive without disease. No patients experienced GIST recurrence. Conclusion: Incidentally finding a synchronous GIST during resection of UGI neoplasms is not uncommon; it may alter surgical treatment but is unlikely to impact longterm survival. Contexte : De nouvelles donnees indiquent que les tumeurs stromales gastro-intestinales (TSGI) asymptomatiques des voies digestives superieures ne sont pas rares. Nous avons voulu etablir leur incidence chez des patients soumis a une resection pour cancer des voies digestives superieures et leur impact sur le traitement chirurgical et adjuvant. Methodes : Nous avons interroge de maniere prospective une base de donnees regroupant tous les patients soumis a une resection de neoplasie non TSGI de l'estomac et de l'oesophage dans un seul centre universitaire sur une periode de 4,5 ans et nous avons passe en revue les rapports d'anatomopathologie pour relever des indications de la presence de TSGI simultanees au niveau des voies digestives superieures. Nous avons compare les caracteristiques demographiques et tumorales des patients, les interventions et les resultats postoperatoires. Resultats : En tout, nous avons inclus 207 patients soumis a une gastrectomie ou a une oesophagectomie pour neoplasie non TSGI. Nous avons releve 15 TSGI simultanees au niveau des voies digestives superieures de 11 patients (5,3 %; 1 a l'etape preoperatoire, 4 durant l'intervention et 10 lors de l'examen anatomopathologique final). Les patients etaient ages en moyenne de 67 ans et en majorite de sexe masculin. D'autres resections ont ete necessaires pour des TSGI reconnues durant la phase preoperatoire ou peroperatoire. Les analyses anatomopathologiques finales ont revele des tumeurs c-kit entierement resequees d'une taille moyenne de 0,5 (entre 0,1 et 4,0) cm assorties d'un risque de malignite faible ou tres faible. Aucun patient n'a recu de traitement adjuvant pour TSGI. Apres un suivi median de 11 (entre 2 et 36) mois, 5 patients sont decedes des suites de leur cancer primitif, 3 etaient toujours en vie avec recurrence de leur cancer primitif et 3 etaient toujours vivants sans signe de maladie. Aucun patient n'a presente de recurrence de TSGI. Conclusion : Il n'est pas rare de trouver de maniere fortuite une TSGI simultanee lors de la resection d'un cancer des voies digestives superieures; cette decouverte peut modifier le traitement chirurgical, mais risque peu d'influer sur la survie a long terme., Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract, accounting for 0.1%-3.0% of all gastrointestinal malignancies. (1-3) These tumours are typically discovered in symptomatic patients [...]