Combined pretherapeutic endoscopic and laparoscopic ultrasonography may predict survival of patients with upper gastrointestinal tract cancer

Mortensen, Michael Bau; Fristrup, Claus Wilki; Ainsworth, Alan Patrick; Nielsen, Henning Overgaard; Pless, Torsten Kjærulf; Hovendal, Claus

doi:10.1007/s00464-010-1258-9

Cited by 11 publications

(3 citation statements)

References 52 publications

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“…The clinical utility of a pretreatment EUS-LUS was evaluated for 936 GI tract cancer patients reported in the March issue of Surgical Endoscopy [1]. The TNM category and resectability groups predicted by EUS-LUS for patients with esophageal (n = 256), gastric (n = 273), or pancreatic (n = 407) cancer were associated with a statistically significant survival difference.…”

Section: To the Editorsmentioning

confidence: 99%

Endoscopic and laparoscopic ultrasonography used to predict tumor staging and improve therapeutic decisions for upper gastrointestinal tract cancer

Hottenrott

2011

Surg Endosc

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To the EditorsDespite advances in imaging technology, including endoscopic ultrasound (EUS), computed tomography (CT), and positron emission tomography (PET), accurate prediction of tumor node metastasis (TNM) staging still remains suboptimal. A high pretreatment prediction rate is very important for surgeons and oncologists. Patients with upper gastrointestinal (GI) tract cancer and distant metastases or unresectable tumors and those with nodal status suggesting noncurative resection (R1, R2) benefit more from primary systemic chemotherapy or chemoradiotherapy than from surgery. A robust pretreatment stage suggesting the potential for complete tumor resection (R0) allows better designing for the extent of surgery and can improve survival.Could the combination of endoscopic and laparoscopic ultrasonography (EUS-LUS) in the pretreatment setting benefit patients with upper GI tract cancer? The clinical utility of a pretreatment EUS-LUS was evaluated for 936 GI tract cancer patients reported in the March issue of Surgical Endoscopy [1]. The TNM category and resectability groups predicted by EUS-LUS for patients with esophageal (n = 256), gastric (n = 273), or pancreatic (n = 407) cancer were associated with a statistically significant survival difference. The authors concluded that the pretherapeutic EUS-LUS was useful for the patient's selection strategy and provided a prognostic outcome similar to data from CT-based populations.Given the need for improving pretreatment TNM status prediction, this large-scale retrospective study can potentially provide useful clinical data. However, more information does not necessarily translate into clinically correct surgical or oncologic decisions. To draw conclusions, comparative-effectiveness research is required to assess, according to strict protocols, whether pretreatment EUS-LUS compared with CT or PET can increase the rates of robust prediction and medical decisions, and whether such decisions translate into improved oncology and quality of life for patients. Such conclusions cannot be drawn from the current study.It has been become clear that apart of imaging technology advances, we need genetic, genomic, molecular diagnostic, and predictive tools. Such biomarkers are urgently needed to predict the pretreatment TNM stage, prognosis, and treatment response for selection of the best possible multimodal treatment for the individual patient. Promises of such personalized decisions and tailored therapy are now provided by the latest advances in cancer genome sequencing and first steps toward understanding gene-expression regulation. By identifying genetic alterations and epigenetic aberrations underlying cancer development and metastases, we can understand the role of transcriptome and micro-RNAs. This exploration of both structure variation and function perturbation of the cancer genome opens one of the most exciting scientific ways for the development of biomarkers with clinical utility .

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Section: To the Editorsmentioning

confidence: 99%

Endoscopic and laparoscopic ultrasonography used to predict tumor staging and improve therapeutic decisions for upper gastrointestinal tract cancer

Hottenrott

2011

Surg Endosc

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“…By intraoperative suspicion of unresectability, LUS can aid in avoiding futile resections, and even more when combined with pretherapeutic EUS [10, 11, 36, 45]. However, little literature exists about the value of US-guided surgery in reducing positive resection margins in pancreatic cancer surgery.…”

Section: Current Strategiesmentioning

confidence: 99%

“…The combination of endoscopic ultrasonography (EUS) and laparoscopic ultrasonography improves resectability assessment [10, 11]. However, microscopic involvement of resection margins (R1 resection) is reported up to 75% of cases, which results in local recurrences and decreased overall survival [12–17].…”

Section: Introductionmentioning

confidence: 99%

Current and Future Intraoperative Imaging Strategies to Increase Radical Resection Rates in Pancreatic Cancer Surgery

Handgraaf

Boonstra

Erkel

et al. 2014

BioMed Research International

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Prognosis of patients with pancreatic cancer is poor. Even the small minority that undergoes resection with curative intent has low 5-year survival rates. This may partly be explained by the high number of irradical resections, which results in local recurrence and impaired overall survival. Currently, ultrasonography is used during surgery for resectability assessment and frozen-section analysis is used for assessment of resection margins in order to decrease the number of irradical resections. The introduction of minimal invasive techniques in pancreatic surgery has deprived surgeons from direct tactile information. To improve intraoperative assessment of pancreatic tumor extension, enhanced or novel intraoperative imaging technologies accurately visualizing and delineating cancer cells are necessary. Emerging modalities are intraoperative near-infrared fluorescence imaging and freehand nuclear imaging using tumor-specific targeted contrast agents. In this review, we performed a meta-analysis of the literature on laparoscopic ultrasonography and we summarized and discussed current and future intraoperative imaging modalities and their potential for improved tumor demarcation during pancreatic surgery.

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Prognostic relevance of gastric cancer staging by endoscopic ultrasound

et al. 2012

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Combined pretherapeutic endoscopic and laparoscopic ultrasonography may predict survival of patients with upper gastrointestinal tract cancer

Abstract: The pretherapeutic EUS-LUS patient stratification related significantly to the final prognosis for UGIC patients. An EUS-LUS-based patient selection strategy seemed to provide a prognostic outcome similar to data from computed tomography (CT)-based populations.

Cited by 11 publications

References 52 publications

Endoscopic and laparoscopic ultrasonography used to predict tumor staging and improve therapeutic decisions for upper gastrointestinal tract cancer

Endoscopic and laparoscopic ultrasonography used to predict tumor staging and improve therapeutic decisions for upper gastrointestinal tract cancer

Current and Future Intraoperative Imaging Strategies to Increase Radical Resection Rates in Pancreatic Cancer Surgery

Prognostic relevance of gastric cancer staging by endoscopic ultrasound

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