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  • 1
    In: Digestive Surgery, S. Karger AG, Vol. 36, No. 6 ( 2019), p. 462-469
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Active surveillance after neoadjuvant therapies has emerged among several malignancies. During active surveillance, frequent assessments are performed to detect residual disease and surgery is only reserved for those patients in whom residual disease is proven or highly suspected without distant metastases. After neoadjuvant chemoradiotherapy (nCRT), nearly one-third of esophageal cancer patients achieve a pathologically complete response (pCR). Both patients that achieve a pCR and patients that harbor subclinical disseminated disease after nCRT could benefit from an active surveillance strategy. 〈 b 〉 〈 i 〉 Summary: 〈 /i 〉 〈 /b 〉 Esophagectomy is still the cornerstone of treatment in patients with esophageal cancer. Non-surgical treatment via definitive chemoradiotherapy (dCRT) is currently reserved only for patients not eligible for esophagectomy. Since salvage esophagectomy after dCRT (50–60 Gy) results in increased complications, morbidity and mortality compared to surgery after nCRT (41.4 Gy), the latter seems preferable in the setting of active surveillance. Clinical response evaluations can detect substantial (i.e., tumor regression grade [TRG] 3–4) tumors after nCRT with a sensitivity of 90%, minimizing the risk of development of non-resectable recurrences. Current scarce and retrospective literature suggests that active surveillance following nCRT might not jeopardize overall survival and postponed surgery could be performed safely. 〈 b 〉 〈 i 〉 Key Message: 〈 /i 〉 〈 /b 〉 Before an active surveillance approach could be considered standard treatment, results of phase III randomized trials should be awaited.
    Type of Medium: Online Resource
    ISSN: 0253-4886 , 1421-9883
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2019
    detail.hit.zdb_id: 1468560-7
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  • 2
    In: Digestive Surgery, S. Karger AG, Vol. 32, No. 5 ( 2015), p. 361-366
    Abstract: 〈 b 〉 〈 i 〉 Background/Aims: 〈 /i 〉 〈 /b 〉 Esophagectomies are associated with high morbidity. To assess the complication severity, the Clavien-Dindo classification (CDC) grades the most severe complication. However, it ignores additional complications that are equal or less severe. The comprehensive complication index (CCI) incorporates all complication severities. It might therefore be a better system to assess the severities. The aim of this study was to validate the CCI compared to the CDC. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 A prospective database was used to analyze 621 patients, who underwent an esophagectomy between 1993 and 2005. The CCI was calculated and the relation with traditional parameters was assessed and compared to the relation of the CDC with these parameters. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Complications occurred in 429 patients (69.1%). The correlation between the CCI and the CDC was r = 0.987, p 〈 0.01. The relation of the CCI with 3 out of 7 parameters was not significantly different compared to the relation of the CDC (p 〉 0.05). There was a significantly stronger relation (p 〈 0.05) of the CCI with length of stay (LOS) (r = 0.663 vs. 0.646), a prolonged LOS (r = 0.542 vs. 0.530), reintervention, (r = 0.437 vs. 0.422) and reoperation rate (0.489 vs. 0.471) than the CDC. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Therefore, the CCI could be a promising scoring system that could be used to identify risks in surgical patient groups.
    Type of Medium: Online Resource
    ISSN: 0253-4886 , 1421-9883
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2015
    detail.hit.zdb_id: 1468560-7
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
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