This thesis examines factors influencing the outcomes of patients receiving multidisciplinary stage-directed treatment for oesophagogastric cancer. The hypotheses tested were: 1.The TNM7 staging system is a more accurate prognostic tool for oesophageal cancer (OC) than TNM6. 2.Use of CT-PET upstages a significant number of patients with occult metastases. 3.OC recurrence patterns differ following definitive chemoradiotherapy (dCRT) and surgery, but overall recurrence rates and survival are comparable for advanced stage disease. 4.An involved circumferential resection margin (CRM+) following oesophagectomy is associated with poorer survival and its incidence can be reduced with neoadjuvant chemoradiotherapy. 5.Early enteral nutrition improves clinical outcomes following upper GI cancer resection. 6.Centralisation of oesophagogastric cancer (OGC) surgery in S.E. Wales is feasible and associated with improved clinical outcomes. Reclassification with TNM7 resulted in stage re-categorisation of 11.9% of OC patients. Multivariate analysis indicated only TNM7 prognostic group to be independently and significantly associated with survival. CT-PET upstaged OC M stage in 24.0% of patients. Loco-regional OC recurrence was commoner after dCRT (p<0.0001) but distant recurrence commoner after surgery (p=0.001). Disease-free survival was better after surgery for stage I (p=0.069) and II (p=0.011) but comparable with dCRT for stage III (p=0.878) and IV (p=0.710). CRM+ occurred in 38.0% of all OC patients, and 62.4% of pT3 patients. Multivariate analysis revealed lymphovascular invasion (p<0.0001) and CRM+ (p=0.002) were independently and significantly associated with disease-free survival. Multivariate analysis revealed EUS T stage (p<0.0001) and neoadjuvant chemoradiotherapy (p<0.0001) were independently associated with CRM+. Early enteral nutrition (EEN) was associated with reduced hospital stay (p=0.023) and less operative morbidity (p=0.044) than control management, due to fewer wound infections (p=0.017), chest infections (p=0.036) and anastomotic leaks (p=0.055). Following centralisation, OGC critical care (p<0.0001) and total hospital stay (p=0.037) were significantly reduced. Serious operative morbidity (Dindo-Clavien grade III+) decreased from 33.3% to 16.7% (p=0.066).
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:567359 |
| Date | January 2012 |
| Creators | Reid, Thomas D. |
| Publisher | Cardiff University |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://orca.cf.ac.uk/37297/ |
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