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Gastroesophageal reflux disease and morbid obesity: To sleeve or not to sleeve?

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World Journal of Gastroenterology 2017年第13期23卷 2269-2275页

作者： Fabrizio Rebecchi Marco E Allaix Marco G Patti francisco schlottmann Mario Morino Department of Surgical Sciences University of Torino Center for Esophageal Diseases and Swallowing University of North Carolina

Laparoscopic sleeve gastrectomy(LSG) has reached wide popularity during the last 15 years, due to the limited morbidity and mortality rates, and the very good weight loss results and effects on comorbid conditions. However, there are concerns regarding the effects of LSG on gastroesophageal reflux disease(GERD). The interpretation of the current evidence is challenged by the fact that the LSG technique is not standardized, and most studies investigate the presence of GERD by assessing symptoms and the use of acid reducing medications only. A few studies objectively investigated gastroesophageal function and the reflux profile by esophageal manometry and 24-h p H monitoring, reporting postoperative normalization of esophageal acid exposure in up to 85% of patients with preoperative GERD, and occurrence of de novo GERD in about 5% of cases. There is increasing evidence showing the key role of the surgical technique on the incidence of postoperative GERD. Main technical issues are a relative narrowing of the mid portion of the gastric sleeve, a redundant upper part of the sleeve(both depending on the angle under which the sleeve is stapled), and the presence of a hiatal hernia. Concomitant hiatal hernia repair is recommended. To date, either medical therapy with proton pump inhibitors or conversion of LSG to laparoscopic Rouxen-Y gastric bypass are the available options for the management of GERD after LSG. Recently, new minimally invasive approaches have been proposed in patients with GERD and hypotensive LES: the LINX? Reflux Management System procedure and the Stretta? procedure. Large studies are needed to assess the safety and long-term efficacy of these new approaches. In conclusion, the recent publication of p H monitoring data and the new insights in the association between sleeve morphology and GERD control have led to a wider acceptance of LSG as bariatric procedure also in obese patients with GERD, as recently stated in the 5^(th) International Consensus Con

关键词： Sleeve gastrectomy Gastroesophageal reflux Morbid obesity Ambulatory p H monitoring Esophageal manometry

Esophagogastric junction adenocarcinoma:Preoperative chemoradiation or perioperative chemotherapy?

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World Journal of Clinical Oncology 2021年第7期12卷 557-564页

作者： francisco Laxague francisco schlottmann Department of Surgery Hospital Alemán of Buenos AiresBuenos Aires 1118Argentina Division of Esophageal and Gastric Surgery Hospital Alemán of Buenos AiresBuenos Aires 1118Argentina

Multimodal treatment is currently the standard of care for locally advanced esophagogastric junction(EGJ)adenocarcinoma due to poor results after surgery *** therapy is intended to shrink the tumor and eliminate potential circulating tumor ***,which neoadjuvant treatment is best for patients with EGJ tumors remains *** aimed to compare outcomes of preoperative chemoradiation and perioperative chemotherapy for EGJ *** this purpose,we performed a thorough review of the literature describing neoadjuvant treatments for EGJ adenocarcinomas or comparing both *** some studies have shown better locoregional control and higher rates of complete pathologic response after chemoradiation,data suggest that both types of neoadjuvant therapy have similar survival *** current data are heterogeneous and many studies have included significantly different types of patients in their analysis,future studies with better patient selection are still needed to define which neoadjuvant therapy should be *** addition,targeted therapies and immunotherapy have promising results and should be further explored.

关键词： Esophageal cancer Esophagogastric junction tumor Esophageal Adenocarcinoma Chemotherapy Chemoradiation Neoadjuvant therapy

Evidence-based approach to the treatment of esophagogastric junction tumors

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World Journal of Clinical Oncology 2022年第3期13卷 159-167页

作者： francisco schlottmann María A Casas Daniela Molena Department of Surgery Hospital Alemán of Buenos AiresBuenos Aires C1118AATArgentina Department of Surgery Memorial Sloan Kettering Cancer CenterNew YorkNY 10065United States

The incidence of esophagogastric junction(EGJ)adenocarcinoma is increasing in developed nations due to the rising prevalence of obesity and gastroesophageal reflux *** to the peculiar location in a histological transition zone between the esophagus and the stomach,the management of EGJ tumors is *** main surgical approaches exist:total gastrectomy with distal esophagectomy or esophagectomy by either transhiatal or transthoracic *** operations differ significantly in the extent of *** addition,patients with locally advanced disease can receive either preoperative chemoradiation or perioperative *** evidence-based review analyzes current evidence regarding the management of EGJ tumors in order to help defining the best surgical and systemic treatment of these patients.

关键词： Esophagogastric junction tumors Esophagectomy Gastrectomy Esophageal adenocarcinoma Chemotherapy Chemoradiation

Surgical outcomes of pulmonary resection for lung cancer after neo-adjuvant treatment

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World Journal of Surgical Procedures 2016年第2期6卷 19-29页

作者： Benedetto Mungo Cheryl K Zogg francisco schlottmann Arianna Barbetta Craig M Hooker Daniela Molena Divisionof Thoracic Surgery Department of SurgeryJohns Hopkins University School of Medicine Thoracic Service Department of SurgeryMemorial Sloan-Kettering Cancer Center

AIM: To evaluate the outcomes of surgery for lung cancer after induction ***: Using the American College of Surgeons National Surgical Quality Improvement Program(ACSNSQIP) database(2005-2012), we identified 4063 patients who underwent a pulmonary resection for lung cancer. Two hundred and thirty-six(5.8%) received neo-adjuvant therapy prior to surgery(64 chemo-radiation, 103 radiation alone, 69 chemotherapy alone). The outcomes were compared to 3827 patients(94.2%) treated with surgery alone. Primary outcome was 30-d mortality, and secondary outcomes included length of stay, operative time and NSQIP measured postoperative ***: Lung cancer patients who received preoperative treatment were younger(66 vs 69, P < 0.001), were more likely to have experienced recent weight loss(6.8% vs 3.5%; P = 0.011), to be active smokers(48.3 vs 34.9, P < 0.001), and had lower preoperative hematological cell counts(abnormal white blood cell: 25.6 vs 13.4; P < 0.001; low hematocrit 53% vs 17.3%, P < 0.001). On unadjusted analysis, neo-adjuvant patients had significantly higher 30-d mortality, overall and serious morbidity(all P < 0.001). Adjusted analysis showed similar findings, while matched cohorts comparison confirmed higher morbidity, but not higher early ***: Our data suggest that patients who receive neo-adjuvant therapy for lung cancer have worse early surgical outcomes. Although NSQIP does not provide stage information, this analysis shows important findings that should be considered when selecting patients for induction treatment.

关键词： Lung cancer Pulmonary resection Neoadjuvant therapy Surgical outcomes