SMH’s Published Research on Gastrointestinal Cancer
Sarasota Memorial’s nationally recognized Cancer Research Department has published numerous cancer-related studies in respected medical journals. Below is a sampling of our team’s recent published research related to gastrointestinal cancers (GI cancer).
For information on current cancer trials, visit our Cancer Clinical Trials webpage. To learn about other medical trials, email Karen-gormley@smh.com or call 941-917-2225.
Safety and Feasibility of Robotic-assisted Ivor-Lewis Esophagectomy
Robotic surgery allows complex resections to be performed with potential benefits over conventional techniques. This study sought to report on a large series of patients undergoing robotic-assisted Ivor-Lewis esophagectomy (RAIL) and assess the safety, feasibility, and reliability of this technology. Results demonstrated that RAIL is a safe surgical technique that provides an alternative to standard minimally invasive and open techniques.
Dis Esophagus. 2018 Jul 1; 31(7)1-7.
Clinical Fate of T0N1 Esophageal Cancer: Results from the National Cancer Database
Neoadjuvant chemoradiation followed by surgical resection remains pivotal in the management of patients with esophageal cancer. However, the outcome of patients whose primary tumor exhibits a complete response with residual regional nodal disease (T0N1) remains unclear as well as the role for adjuvant therapy. The purpose of this study was to determine the significance of a pathologic T0N1 diagnosis, the overall prognosis for these patients and whether they will benefit from additional therapy. Results demonstrated that the addition of adjuvant therapy is beneficial for node positive patients but showed no benefit for pathologic T0N1 patients. Unfortunately, the diagnosis of T0N1 had worse survival outcomes than a diagnosis of pathological complete response and had no better survival than T1/2 patients.
J Gastrointest Oncol. 2018;9(5)880-886.
Accuracy of Endoscopic Ultrasound Staging for T2N0 Esophageal Cancer: A National Cancer Database Analysis
The accuracy of staging for clinical T2N0 esophageal cancer is one of the most important factors when considering treatment recommendations for preoperative therapy. The purpose of this study was to determine the accuracy of clinical staging of T2N0 esophageal cancer utilizing the National Cancer Database. Results showed that the overall accuracy of clinical staging pathologically was only 30.7% and decreased with time. Factors related to pathologic upstaging included younger age, tumor length greater than 3 cm, high grade tumors, and high volume esophagectomy centers.
J Gastrointest Oncol. 2018;9(5)887-893.
Anastomotic Leak and Neoadjuvant Chemoradiotherapy in Esophageal Cancer
Most patients receive neoadjuvant chemoradiation prior to esophagectomy which has been associated with increase perioperative complications and mortality. Anastomotic leaks cause significant morbidity after esophagectomy. This study compared anastomotic leak rates in upfront surgical and neoadjuvant chemoradiation patients. Results showed that there was no difference in the anastomotic leak rate between upfront surgical and neoadjuvant chemoradiation patients. A decreased anastomotic leak rate was observed in patients with distal esophageal tumors and thoracic anastomosis.
J Gastrointest Oncol. 2018;9(5)894-902.
Esophagectomy from Then to Now
Surgical resection is pivotal for the long-term survival in patients with locally advanced esophageal cancer. Advancements in surgical techniques have contributed to reductions in morbidity. This paper is a review of the evolution from open esophagectomy to the most recent robotic approach.
J Gastrointest Oncol. 2018;9(5)903-909.
Correlation of Tumor Size and Survival in Pancreatic Cancer
Neoadjuvant therapy for resectable pancreatic adenocarcinoma continues to be debated. This study sought to establish the relationship between pancreatic tumor size, neoadjuvant chemotherapy, neoadjuvant chemoradiation, and definitive surgery on survival. Results showed that neoadjuvant chemotherapy had the most significant improvements in both tumor size greater than 2 and less than 2 cm.
J Gastrointest Oncol. 2018;9(5)910-921.
Outcomes Associated with Robotic Approach to Pancreatic Resections
Minimally invasive techniques have improved post-operative outcomes, however, pancreatic surgery is complex and the majority of surgeries are still performed via open approaches. This study presented a single surgeon’s application of robotics to pancreatic resection and assessed the learning curve associated with this approach. Results demonstrated the robotics system is advantageous and there is improvement in operative time and postoperative complications with increased case volume. The learning curve associated with robotic pancreatic surgery is extensive and dependent on surgeon volume and experience with robotic surgery.
J Gastrointest Oncol. 2018;9(5)936-941.
The Accuracy of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio as a Marker for Gastrointestinal Malignancies
Accurate predictors of locally advanced and recurrent disease in patients with gastrointestinal cancer are currently lacking. This study sought to evaluate the utility of neutrophil-lymphocyte and platelet-lymphocyte ratios in predicting the presence of regional nodal disease, metastasis and systemic recurrence in patients with gastrointestinal malignancies. Results demonstrated that elevation of neutrophil-lymphocyte and platelet-lymphocyte ratios in patients with GI malignancies can be used to help identify advanced disease and recurrence after surgery. Failure of neutrophil-lymphocyte and platelet-lymphocyte ratios to normalize three months post resection may indicate early recurrence or persistent disease.
J Gastrointest Oncol. 2018;9(5)972-978.
Neoadjuvant Therapy and Pancreatic Cancer: A National Cancer Database Analysis
This study examined the impact of neoadjuvant chemotherapy and neoadjuvant chemoradiation on survival in pancreatic cancer patients. Results showed that neoadjuvant therapy improves survival in resectable pancreatic cancer patients. Neoadjuvant chemotherapy and neoadjuvant chemoradiation patients demonstrated survival benefit compared to upfront surgery patients, even with adjuvant therapy.
J Gastrointest Oncol. 2019;10(4)663-673.
Comparative Outcomes of Minimally Invasive and Robotic Assisted Esophagectomy
Minimally invasive esophagectomy has demonstrated superior outcomes compared to open surgical approaches. The robotic technique potentially has additional benefits. This study examined the outcomes of minimally invasive esophagectomy including robotics. Results showed the thoracoscopic/laparoscopic and robotic approaches had decreased blood loss, improved R0 resection, higher lymph node yield and less morbidity when compared to the transhiatal approach.
Surg Endosc. 2019;Epub 10 June 2019.
Comparative Perioperative Outcomes by Esophagectomy Surgical Technique
Surgical resection is vital in the curative management of patients with esophageal cancer. This study compared different esophagectomy techniques and reported on the perioperative outcomes. Results showed minimally invasive and robotic Ivor-Lewis techniques had substantial benefits in post-operative complications and oncologic outcomes.
J Gastrointest Surg. 2019;Epub 13 June 2019.