Esophageal Cancer: HMIE Procedure Reduces Morbidity Without Sacrificing Efficacy

MedicalResearch.com Interview with:

Guillaume Piessen, MD, PhD University Hospital Centre Lille, France

Prof. Piessen

Guillaume Piessen, MD, PhD
University Hospital Centre
Lille, Franc

MedicalResearch.com: What is the background for this study?

Response: Patients requiring surgery for esophageal cancer fare better after undergoing a hybrid minimally invasive esophagectomy (HMIE) with a combined laparoscopy+thoracotomy procedure compared to an open esophagectomy (OE), according to results of the MIRO trial published in the last issue of the New England Journal Of Medicine (link article).

This French prospective multi-center randomized controlled study was funded by the French National Cancer Institute (Grant n° 1907). The study was conducted by Pr Mariette who sadely passed away in 2017 and Pr Piessen (Department of Digestive and Oncological Surgery, CHU Lille), under the hauspice of FRENCH (Fédération de Recherche EN Chirurgie) and FREGAT (French Eso-Gastric Tumors) working group (https://www.fregat-database.org/fr/).

Postoperative morbidity, especially pulmonary complications, affects more than half of patients after open esophagectomy for esophageal cancer.

Hybrid minimally invasive esophagectomy (HMIE) combines a laparoscopic abdominal phase with an open thoracotomy, which may have specific advantages including lower rate of pulmonary complications, without laparoscopic tumor dissection limiting potential tumor spillage and easier reproducibility of the technique [12].

Postoperative morbidity, especially pulmonary complications, affects more than half of patients after open esophagectomy for esophageal cancer.

Hybrid minimally invasive esophagectomy (HMIE) combines a laparoscopic abdominal phase with an open thoracotomy, which may have specific advantages including lower rate of pulmonary complications, without laparoscopic tumor dissection limiting potential tumor spillage and easier reproducibility of the technique [12].

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HPV Status Influences Survival in Esophageal Cancer

MedicalResearch.com Interview with:

Barrett's Esophagus -wikipedia

Barrett’s Esophagus -wikipedia

Shan Rajendra MBBCh, MSc , MD, FRCP, FRACP
Professor of Medicine
University of New South Wales
Director of Medicine & Clinical Executive Director
Bankstown-Lidcombe Hospital
Director Gastro-Intestinal Viral Oncology Group
Ingham Institute for Applied Medical Research
Sydney 

MedicalResearch.com: What is the background for this study?  

Response: High-risk human papillomavirus(HPV)  infection has been strongly associated with a subset of Barrett’s dysplasia and oesophageal adenocarcinoma.

The research question was; Does HPV status of Barrett’s high-grade dysplasia and esophageal adenocarcinoma influence survival as in viral positive head and neck cancers?

We therefore sought to determine the prognostic significance of esophageal tumor HPV status and associated viral transcriptional markers (E6/E7 mRNA and p16INK4A) and TP53.

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HOT Tea Raises Risk of Esophageal Cancer

MedicalResearch.com Interview with:
“Hot tea #steam” by Thomas Ricker is licensed under CC BY 2.0Jun / 吕筠

Professor, Department of Epidemiology & Biostatistics
School of Public Health, Peking University Health Science Center
Beijing 100191 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Esophageal cancer (EC) remains a global concern because of its increasing incidence and persistently poor survival. It poses a bigger threat to less developed regions and men.

Tea is one of the most common beverages worldwide and usually consumed at elevated temperature. Existing evidence remains inconclusive as to the association between tea consumption and EC risk. Tea consumers, especially in Chinese men, are more likely to smoke and drink alcohol. Tobacco smoking and alcohol consumption, as well as the chemical compounds and adverse thermal effect of high-temperature tea, considerably complicate the association between tea consumption and esophageal cancer risk.

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Genetic Diversity Test Distinguishes Risk of Cancer in Barrett’s Esophagus

MedicalResearch.com Interview with:

Prof. Trevor A Graham, MSc, MRes, PhD Lead, Evolution and Cancer Laboratory Centre for Tumour Biology Barts Cancer Institute, Queen Mary University of London John Vane Science Centre London

Prof. Trevor Graham

Prof. Trevor A Graham, MSc, MRes, PhD
Lead, Evolution and Cancer Laboratory
Centre for Tumour Biology
Barts Cancer Institute, Queen Mary University of London
John Vane Science Centre
London

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Barrett’s Oesophagus is a common condition that affects an estimated 1.5 million people in the UK alone, although many are undiagnosed . This condition involves normal cells in the oesophagus (food pipe) being replaced by a different, unusual cell type called Barrett’s Oesophagus, and the replacement of the cells is thought to be a consequence of chronic reflux (heartburn).

People with Barrett’s have an increased risk of developing oesophageal cancer – a cancer that sadly still has a five year survival of 15% . But although the overall lifetime risk of developing oesophageal cancer in people with Barrett’s is significant (some estimates suggest the risk is comparable to that associated with smoking and lung cancer), the risk for each patient per year is very low.

This presents a big problem – most Barrett’s patients will never develop cancer in their lifetime, but the unfortunate few develop an aggressive cancer. Doctors urgently need better tools to distinguish which people with Barrett’s are actually at risk of developing cancer, so that they can receive the best treatment, and everyone else at low risk of cancer can be reassured and not need to endure unnecessary treatment. But because good a way to distinguish high-risk people doesn’t exist, all people with Barrett’s have regular (every 3 years or thereabouts) endoscopy; a camera pushed into the oesophagus to look for early signs of cancer.

Together with Prof Sheila Krishnadath  and her colleagues at the Amsterdam Medical Centre, Holland, we confirmed that we can identify people at high risk of developing cancer from pre-cancerous condition Barrett’s oesophagus by measuring the genetic diversity of Barrett’s cells.

Importantly, we also showed level of genetic diversity amongst a person’s Barrett’s cells essentially being fixed over time – no significant changes in genetic diversity were found during the ~4 years that the patients were followed. This means that whenever someone’s Barrett’s is tested, it looks like their future risk of developing cancer can be predicted regardless of how long it’s been since the abnormal Barrett’s cells began to appear.

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Does Malpractice Fear Drive Overuse of Esophageal Cancer Screening?

Megan A. Adams, MD Gastroenterology Fellow University of MichiganMedicalResearch.com Interview with
Megan A. Adams, MD
Gastroenterology Fellow
University of Michigan

 

Medical Research: What are the main findings of the study?

Dr. Adams: Surveys of doctors indicate that their fear of a malpractice lawsuit for missing a diagnosis of esophageal cancer might drive the overuse of tests called upper endoscopies in patients who are at low risk for the cancer. To examine whether this perception of medical liability risk accurately reflects the real likelihood of a malpractice claim, we looked at a national database of malpractice claims, and compared the rate of claims for delay in diagnosis of esophageal cancer in patients without alarm symptoms (weight loss, dysphagia, iron deficiency anemia), with the rate of claims alleging performance of an upper endoscopy without a good reason for performing the procedure.

The database contained 278,220 claims filed against physicians in 1985-2012. The incidence of reported medical liability claims for failure to screen for esophageal cancer in patients without alarm features was quite low (19 claims in 11 years, 4 paid). In contrast, there were 17 claims in 28 years for complications of upper endoscopies with questionable indication (8 paid).

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Tallness May Be Protective Against Esophageal Cancer

Dr. Aaron P. Thrift PhD Public Health Sciences Division Fred Hutchinson Cancer Research Center Seattle, WA.MedicalResearch.com: Interview with:
Dr. Aaron P. Thrift PhD
Public Health Sciences Division
Fred Hutchinson Cancer Research Center
Seattle, WA.


Medical Research: What are the main findings of the study?

Dr. Thrift: We conclude that height is inversely associated with risk of esophageal adenocarcinoma, both in men and women. The association is not due to confounding from known risk factors or bias.
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