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Tumor Biology: Is It Time to Redefine Unresectability? An Extraordinary Case of Gastroesophageal Junctional Adenocarcinoma

Background: Disease assessment based on measurements of size and anatomic involvement have historically been central to surgical strategy. We propose this to be an outdated concept, which should be replaced by a deeper understanding of tumor biology and careful treatment planning. Report of case: A...

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Detalles Bibliográficos
Autores principales: Gaya, Andy, Giakoustidis, Alex, Winslet, Mark, Mudan, Satvinder
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4725854/
https://www.ncbi.nlm.nih.gov/pubmed/26835191
http://dx.doi.org/10.7759/cureus.420
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author Gaya, Andy
Giakoustidis, Alex
Winslet, Mark
Mudan, Satvinder
author_facet Gaya, Andy
Giakoustidis, Alex
Winslet, Mark
Mudan, Satvinder
author_sort Gaya, Andy
collection PubMed
description Background: Disease assessment based on measurements of size and anatomic involvement have historically been central to surgical strategy. We propose this to be an outdated concept, which should be replaced by a deeper understanding of tumor biology and careful treatment planning. Report of case: A 34-year-old male was diagnosed with a Siewert Type 3 locally advanced cancer of the gastroesophageal junction, involving the coeliac axis and the superior mesenteric artery (SMA). He was treated with neoadjuvant chemotherapy, followed by chemoradiation, and then proceeded to surgery, at which time the tumor was judged unresectable. After extensive planning, a further surgery was attempted - an extended gastrectomy with distal esophagectomy, left hepatectomy, and splenectomy were performed. Additionally, the coeliac axis and the SMA were excised, followed by reconstruction of the hepatic artery and the SMA with grafts. Adjuvant chemotherapy was administered, and the patient is recurrence-free after five years follow-up. Conclusion: This case highlights the importance of the distinction between resectability and operability, and that patient treatment should be tailored and individualised based on the response to treatment, comorbidities, and underlying tumor biology.
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spelling pubmed-47258542016-02-01 Tumor Biology: Is It Time to Redefine Unresectability? An Extraordinary Case of Gastroesophageal Junctional Adenocarcinoma Gaya, Andy Giakoustidis, Alex Winslet, Mark Mudan, Satvinder Cureus Gastroenterology Background: Disease assessment based on measurements of size and anatomic involvement have historically been central to surgical strategy. We propose this to be an outdated concept, which should be replaced by a deeper understanding of tumor biology and careful treatment planning. Report of case: A 34-year-old male was diagnosed with a Siewert Type 3 locally advanced cancer of the gastroesophageal junction, involving the coeliac axis and the superior mesenteric artery (SMA). He was treated with neoadjuvant chemotherapy, followed by chemoradiation, and then proceeded to surgery, at which time the tumor was judged unresectable. After extensive planning, a further surgery was attempted - an extended gastrectomy with distal esophagectomy, left hepatectomy, and splenectomy were performed. Additionally, the coeliac axis and the SMA were excised, followed by reconstruction of the hepatic artery and the SMA with grafts. Adjuvant chemotherapy was administered, and the patient is recurrence-free after five years follow-up. Conclusion: This case highlights the importance of the distinction between resectability and operability, and that patient treatment should be tailored and individualised based on the response to treatment, comorbidities, and underlying tumor biology. Cureus 2015-12-21 /pmc/articles/PMC4725854/ /pubmed/26835191 http://dx.doi.org/10.7759/cureus.420 Text en Copyright © 2015, Gaya et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Gastroenterology
Gaya, Andy
Giakoustidis, Alex
Winslet, Mark
Mudan, Satvinder
Tumor Biology: Is It Time to Redefine Unresectability? An Extraordinary Case of Gastroesophageal Junctional Adenocarcinoma
title Tumor Biology: Is It Time to Redefine Unresectability? An Extraordinary Case of Gastroesophageal Junctional Adenocarcinoma
title_full Tumor Biology: Is It Time to Redefine Unresectability? An Extraordinary Case of Gastroesophageal Junctional Adenocarcinoma
title_fullStr Tumor Biology: Is It Time to Redefine Unresectability? An Extraordinary Case of Gastroesophageal Junctional Adenocarcinoma
title_full_unstemmed Tumor Biology: Is It Time to Redefine Unresectability? An Extraordinary Case of Gastroesophageal Junctional Adenocarcinoma
title_short Tumor Biology: Is It Time to Redefine Unresectability? An Extraordinary Case of Gastroesophageal Junctional Adenocarcinoma
title_sort tumor biology: is it time to redefine unresectability? an extraordinary case of gastroesophageal junctional adenocarcinoma
topic Gastroenterology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4725854/
https://www.ncbi.nlm.nih.gov/pubmed/26835191
http://dx.doi.org/10.7759/cureus.420
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