Full-thickness myotomy (FTM) offers clinical outcomes similar to circular muscle myotomy (CMM) for achalasia, but carries additional safety risks. Clinical success rates: 91.2% for FTM vs. 85.7% for CMM; noninferiority demonstrated. Higher insufflation-related events with FTM at 32.35% vs. 11.43% for CMM (p = .035). Surgical teams should weigh the similar efficacy against the increased […]
Category: Upper Gastrointestinal Tract
EUS-Guided Gastroenterostomy Outperforms Surgical Options in MGO
EUS-guided gastroenterostomy (EUS-GE) shows superior outcomes for malignant gastric outlet obstruction (MGO) compared to traditional surgical approaches. EUS-GE has a re-intervention rate of just 17% compared to 30% for surgical gastrojejunostomy (SGJ) and significantly lower than enteral stenting. Clinical success rates are higher with EUS-GE (20% more successful than enteral stenting). EUS-GE shortens hospital stay […]
Genomic Insights Enhance Gastric Cancer Outcome Predictions
Molecular profiling of gastric cancer tumors can improve risk stratification for recurrence post-surgery. In a study of 438 patients, 179 experienced recurrence after resection. Alterations in the KRAS gene (HR 1.54) and PIK3CA (HR 2.15) were linked to poorer disease-free survival. Patients with hematogenous recurrence had significant chromosomal instability, suggesting personalized surveillance may be beneficial. […]
Lymph Node Harvest of 25+ Improves Survival in Esophageal Cancer
A multicenter study shows that removing at least 25 lymph nodes during surgery for esophageal adenocarcinoma post-chemotherapy leads to better outcomes. An optimal yield of 25 nodes resulted in a 29% reduction in mortality (HR: 0.714, p=0.0017) for chemotherapy patients. Those with ≥25 lymph nodes had approximately 44% lower mortality compared to chemoradiotherapy cases (HR=0.563, […]
Robotic Gastrectomy Cuts Complications in Advanced Gastric Cancer
Robotic gastrectomy significantly lowers severe complications and boosts treatment outcomes in patients with advanced gastric cancer. Severe complications dropped to 2.6% with robotic surgery compared to 9.7% with laparoscopic (p=0.016). Chemotherapy completion improved to 63.6% in robotic cases versus 40.5% in laparoscopic (p=0.026). Higher estimated 5-year overall survival at 71.7% vs. 52.0% (p=0.046) for robotic […]
New G-CMAP Score Predicts Complications After Gastrectomy
A novel 8-point G-CMAP score can help surgeons predict postoperative complications after gastrectomy for gastric cancer, enhancing patient selection. Postoperative complications occurred in 18% of patients. Key predictors include C-reactive protein, monocyte count, serum albumin, and prothrombin time. This tool shows modest predictive ability (AUC 0.68) and can guide clinical decision-making for better surgical outcomes. […]
Circulating Tumor DNA Predicts Recurrence in Esophageal Cancer
Assessing circulating tumor DNA (ctDNA) in patients with esophageal squamous cell carcinoma (ESCC) identifies high recurrence risk after surgery. Pre-neoadjuvant chemotherapy, ctDNA was detected in 100% of advanced stages and 50% of stage I. Recurrence rates soared to 77.8% in ctDNA-positive patients versus 27.8% in ctDNA-negative patients, with a hazard ratio of 4.56. Consider ctDNA […]
Survival Advantage with Neoadjuvant Chemotherapy in Esophageal Cancer
Neoadjuvant chemotherapy (NCT) significantly improves long-term survival in patients with esophageal and esophagogastric junction adenocarcinoma compared to chemoradiotherapy (NCRT). Overall survival rates at 1, 3, and 5 years with NCT were 95.4%, 81.5%, and 73.8% versus 87.8%, 64.8%, and 56% for NCRT (p < 0.001). Disease-free survival also favored NCT, with a substantially reduced risk […]
Log Odds of Lymph Nodes Enhance Risk Prediction Post-Esophagectomy
Researchers found that the log odds of positive lymph nodes significantly improve risk stratification for early recurrence after radical esophagectomy in cT3 esophageal squamous cell carcinoma. Higher log odds predict early recurrence; significant cut-off at -2.69. Patients with log odds > -2.69 have a 30% 5-year survival rate versus 66% for those ≤ -2.69 (p […]
Surgery for Gastroesophageal Junction Cancers May Be Omitted
New data raises the question of whether surgery can be skipped for certain gastric and gastroesophageal junction cancers with high pathologic complete response rates. Patients with mismatch-repair deficient tumors have a 60% pathologic complete response to neoadjuvant immunotherapy. Those with mismatch repair intact tumors show about 20% pathologic complete response with chemo-immunotherapy. Surgeons should consider […]