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Multimodal Treatment of Gastrointestinal Tract Tumors: Consequences for Surgery

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Abstract

Formerly an exclusive business of surgery, gastrointestinal (GI) tumors are nowadays increasingly approached with multimodal strategies. Neoadjuvant concepts have had a particularly far-reaching impact on surgery and have contributed to improved survival. Modern pre-treatment staging and risk assessment provide the basis for decision on one of three general treatment concepts (1) Early cancers, confined to the mucosal/submucosal layers, are approached with primary surgery, without prior antineoplastic therapy. (2) Systemically metastasized tumors receive merely palliative treatment. (3) Locally advanced cancers are increasingly approached with neoadjuvant strategies. The benefit from these preoperative protocols is proven for diverse entities, but is evidently confined to a specific subgroup patients, i.e., the responders to neoadjuvant treatment. These are the ones benefiting most from subsequent surgical resection, which is required to ensure complete removal of the residual tumor tissue, as complete tumor regression occurs very rarely and cannot be proven without a specimen. The fact that responders will benefit and non-responders will not benefit or will even deteriorate during the neoadjuvant treatment makes early response prediction most demanding. An amazing new approach is the use of position emission tomography with fluro-desoxyglucose (FDG-PET) to assess the “metabolic response,” which is possible as early as 14 days after initiation of the neoadjuvant protocol. This strategy offers the chance for modulating the surgical approach in accord i.e., with such metrobolic response termination of the protocol and proceeding to resection in the case of non-response.

The future of GI cancer surgery is multimodal therapy in a response-based fashion and requires reponse-based trials for further evaluation.

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References

  1. HJ Stein JR Siewert (2004) ArticleTitleImproved prognosis of resected esophageal cancer World J. Surg. 28 520–525 Occurrence Handle10.1007/s00268-004-7417-1 Occurrence Handle15366737

    Article  PubMed  Google Scholar 

  2. Stein HJ, von Rahden BHA, Siewert JR. Survival after oesophagectomy for cancer of the oesophagus. Langenbecks Arch. Surg. 2004 Jul 14

  3. HL Westreenen Particlevan M Westerterp PM Bossuyt et al. (2004) ArticleTitleSystematic review of the staging performance of 18F-fluorodeoxyglucose positron emission tomography in esophageal cancer J. Clin. Oncol. 22 3805–3812 Occurrence Handle10.1200/JCO.2004.01.083 Occurrence Handle15365078

    Article  PubMed  Google Scholar 

  4. M Selzner TF Hany P Wildbrett et al. (2004) ArticleTitleDoes the novel PET/CT imaging modality impact on the treatment of patients with metastatic colorectal cancer of the liver? Ann. Surg. 240 1027–1034 Occurrence Handle10.1097/01.sla.0000146145.69835.c5 Occurrence Handle15570208

    Article  PubMed  Google Scholar 

  5. T Lerut P Flamen N Ectors et al. (2000) ArticleTitleHistopathologic validation of lymph node staging with FDG-PET scan in cancer of the esophagus and gastroesophageal junction: a prospective study based on primary surgery with extensive lymphadenectomy Ann. Surg. 232 743–752 Occurrence Handle10.1097/00000658-200012000-00003 Occurrence Handle1:STN:280:DC%2BD3M%2FltVyntA%3D%3D Occurrence Handle11088069

    Article  CAS  PubMed  Google Scholar 

  6. H Bartels HJ Stein JR Siewert (2000) ArticleTitleRisk analysis in esophageal surgery Recent Results Cancer Res. 155 89–96 Occurrence Handle1:STN:280:DC%2BD3c7lslKgsg%3D%3D Occurrence Handle10693241

    CAS  PubMed  Google Scholar 

  7. H Bartels HJ Stein JR Siewert (1998) ArticleTitlePreoperative risk analysis and postoperative mortality of oesophagectomy for resectable oesophageal cancer Br. J. Surg. 85 840–844 Occurrence Handle10.1046/j.1365-2168.1998.00663.x Occurrence Handle1:STN:280:DyaK1czjtVaqtg%3D%3D Occurrence Handle9667720

    Article  CAS  PubMed  Google Scholar 

  8. PM Schlag A Bembenek T Schulze (2004) ArticleTitleSentinel node biopsy in gastrointestinal-tract cancer Eur. J. Cancer 40 2022–2032 Occurrence Handle10.1016/j.ejca.2004.04.033 Occurrence Handle1:STN:280:DC%2BD2cvjs1KntA%3D%3D Occurrence Handle15341974

    Article  CAS  PubMed  Google Scholar 

  9. Y Kitagawa M Kitajima (2004) ArticleTitleLymphatic mapping for upper gastrointestinal malignancies Semin. Oncol. 31 409–414 Occurrence Handle10.1053/j.seminoncol.2004.03.016 Occurrence Handle15190499

    Article  PubMed  Google Scholar 

  10. Y Kitagawa H Fujii M Mukai et al. (2004) ArticleTitleCurrent status and future prospects of sentinel node navigational surgery for gastrointestinal cancers Ann. Surg. Oncol. 11 IssueID3 Suppl 242S–244S Occurrence Handle10.1245/ASO.2004.12.914 Occurrence Handle15023760

    Article  PubMed  Google Scholar 

  11. H Fujii Y Kitagawa M Kitajima et al. (2004) ArticleTitleSentinel node of malignancies originating in the alimentary tract Ann. Nucl. Med. 18 1–12 Occurrence Handle15072178 Occurrence Handle10.1007/BF02985608

    Article  PubMed  Google Scholar 

  12. M Burian HJ Stein A Sendler et al. (2004) ArticleTitle[Sentinel lymph node mapping in gastric and esophageal carcinomas] Chirurg 75 756–760 Occurrence Handle10.1007/s00104-004-0909-6 Occurrence Handle1:STN:280:DC%2BD2cvgsVCgsw%3D%3D Occurrence Handle15278234

    Article  CAS  PubMed  Google Scholar 

  13. M Burian HJ Stein A Sendler et al. (2004) ArticleTitleSentinel node detection in Barrett’s and cardia cancer Ann. Surg. Oncol. Mar;11 IssueID3 Suppl 255S–258S Occurrence Handle10.1245/ASO.2004.12.915

    Article  Google Scholar 

  14. JD Urschel H Vasan (2003) ArticleTitleA meta-analysis of randomized controlled trials that compared neoadjuvant chemoradiation and surgery to surgery alone for resectable esophageal cancer Am. J. Surg. 185 538–543 Occurrence Handle10.1016/S0002-9610(03)00066-7 Occurrence Handle12781882

    Article  PubMed  Google Scholar 

  15. IG Kaklamanos GR Walker K Ferry et al. (2003) ArticleTitleNeoadjuvant treatment for resectable cancer of the esophagus and the gastroesophageal junction: a meta-analysis of randomized clinical trials Ann. Surg. Oncol. 10 754–761 Occurrence Handle10.1245/ASO.2003.03.078 Occurrence Handle12900366

    Article  PubMed  Google Scholar 

  17. DP Kelsen R Ginsberg TF Pajak et al. (1998) ArticleTitleChemotherapy followed by surgery compared with surgery alone for localized esophageal cancer N. Engl. J. Med. 339 1979–1984 Occurrence Handle10.1056/NEJM199812313392704 Occurrence Handle1:STN:280:DyaK1M%2FnslCjsg%3D%3D Occurrence Handle9869669

    Article  CAS  PubMed  Google Scholar 

  18. JR Siewert HJ Stein M Feith et al. (2001) ArticleTitleHistologic tumor type is an independent prognostic parameter in esophageal cancer: lessons from more than 1,000 consecutive resections at a single center in the Western world Ann. Surg. 234 360–367 Occurrence Handle10.1097/00000658-200109000-00010 Occurrence Handle1:STN:280:DC%2BD3MvotVylsQ%3D%3D Occurrence Handle11524589

    Article  CAS  PubMed  Google Scholar 

  20. R Sauer H Becker W Hohenberger et al. (2004) ArticleTitlePreoperative versus postoperative chemoradiotherapy for rectal cancer N. Engl. J. Med. 351 1731–1740 Occurrence Handle10.1056/NEJMoa040694 Occurrence Handle1:CAS:528:DC%2BD2cXovFSksbo%3D Occurrence Handle15496622

    Article  CAS  PubMed  Google Scholar 

  21. E Kapiteijn CA Marijnen ID Nagtegaal et al. (2001) ArticleTitlePreoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer N. Engl. J. Med. 345 638–646 Occurrence Handle10.1056/NEJMoa010580 Occurrence Handle1:STN:280:DC%2BD3Mvps1ektw%3D%3D Occurrence Handle11547717

    Article  CAS  PubMed  Google Scholar 

  22. Swedish Rectal Cancer Trial. Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N. Engl. J. Med. 1997;336:980–987

    Google Scholar 

  23. K Becker JD Mueller C Schulmatcher et al. (2003) ArticleTitleHistomorphology and grading of regression in gastric carcinoma treated with neoadjuvant chemotherapy Cancer 98 1521–1530 Occurrence Handle10.1002/cncr.11660 Occurrence Handle14508841

    Article  PubMed  Google Scholar 

  24. BL Bruecher W Weber M Bauer et al. (2001) ArticleTitleNeoadjuvant therapy of esophageal squamous cell carcinoma: response evaluation by positron emission tomography Ann. Surg. 233 300–309 Occurrence Handle10.1097/00000658-200103000-00002

    Article  Google Scholar 

  25. BL Brucher HJ Stein F Zimmermann et al. (2004) ArticleTitleResponders benefit from neoadjuvant radiochemotherapy in esophageal squamous cell, carcinoma: results of a prospective phase-II trial Eur. J. Surg. Oncol. 30 963–971 Occurrence Handle10.1016/j.ejso.2004.06.008 Occurrence Handle1:STN:280:DC%2BD2crislOrug%3D%3D Occurrence Handle15498642

    Article  CAS  PubMed  Google Scholar 

  26. K Ott WA Weber U Fink et al. (2003) ArticleTitleFluorodeoxyglucose-positron emission tomography in adenocarcinomas of the distal esophagus and cardia World J. Surg. 27 1035–1039 Occurrence Handle10.1007/s00268-003-7058-9 Occurrence Handle12917760

    Article  PubMed  Google Scholar 

  27. WA Weber K Ott K Becker et al. (2001) ArticleTitlePrediction of response to preoperative chemotherapy in adenocarcinomas of the esophagogastric junction by metabolic imaging J. Clin. Oncol. 19 3058–3065 Occurrence Handle1:STN:280:DC%2BD3MzksFGhsQ%3D%3D Occurrence Handle11408502

    CAS  PubMed  Google Scholar 

  28. K Ott U Fink K Becker et al. (2003) ArticleTitlePrediction of response to preoperative chemotherapy in gastric carcinoma by metabolic imaging: results of a prospective trial J. Clin. Oncol. 21 4604–4610 Occurrence Handle10.1200/JCO.2003.06.574 Occurrence Handle1:CAS:528:DC%2BD2cXpsVWqurg%3D Occurrence Handle14673049

    Article  CAS  PubMed  Google Scholar 

  29. CD Heidecke H Weighardt M Feith et al. (2002) ArticleTitleNeoadjuvant treatment of esophageal cancer: immunosuppression following combined radiochemotherapy Surgery 132 495–501 Occurrence Handle10.1067/msy.2002.127166 Occurrence Handle12324764

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675, Munich, Germany

    J. Rüdiger Síewert M.D., Hubert J. Stein M.D., FACS & Burkhard H.A. von Rahden M.D.

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  1. J. Rüdiger Síewert M.D.
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  2. Hubert J. Stein M.D., FACS
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  3. Burkhard H.A. von Rahden M.D.
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Corresponding author

Correspondence to Burkhard H.A. von Rahden M.D..

Additional information

This manuscript is based on the ISS-Lecture of Univ.-Prof. Dr. Dr. h. c. Rüdiger Siewert, held at the ISDS World Congress/Yokohama December 2004

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Síewert, J.R., Stein, H. & von Rahden, B.H. Multimodal Treatment of Gastrointestinal Tract Tumors: Consequences for Surgery . World J. Surg. 29, 940–948 (2005). https://doi.org/10.1007/s00268-005-0010-4

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