Background/Objectives: Adenocarcinomas of the esophagogastric junction and stomach present clinical entities with significant cancer-related morbidity and mortality, often requiring multimodal treatments. Preoperative chemotherapy, mainly the FLOT regimen, is increasingly being utilized in the neoadjuvant setting for the treatment of these malignancies, with varying degrees of tumor response. Methods: We conducted a retrospective, single-institution review on 75 patients operated on for adenocarcinoma of the esophagogastric junction and stomach after neoadjuvant FLOT. We investigated whether tumor response correlates with disease response in lymph nodes examined on surgical specimens. We also investigated the role of tumor-infiltrating lymphocytes (TILs) in correlation with primary tumor response and disease response in lymph nodes on pathological specimens. Results: Our results suggest that TILs correlate in a differential manner with regards to primary tumors versus lymph nodes, thus suggesting that there are different biologic processes in place. Conclusions: Our results provide unique evidence on tumor-infiltrating lymphocytes in the adenocarcinoma histology of the esophagogastric junction and stomach and might be important for further studies.

Objective: To investigate the prevalence of tumor deposits in gastric cancer patients across different T and N stages as well as other pathologic parameters. Another goal of the study is to identify the potential impact of tumor deposit positivity on 5-year overall survival. Background: Tumor deposits represent an increasingly recognized pathologic entity in resected surgical specimens of gastric adenocarcinoma patients. Their prevalence across different T and N stages and according to lymphovascular and perineural invasion, as well as across different grades remains largely unknown. Methods: We have undertaken a systematic literature review in the PubMed and Cochrane databases with meta-analysis of data from published studies. Raw data were extracted from studies to calculate the prevalence of tumor deposits across all T, N stages, positive/negative lymphovascular, and perineural invasion status, as well as according to tumor grade. Pooled prevalence for the calculated values was performed with a meta-analysis of extracted data. Pooled hazard ratios for 5-year overall survival hazard ratio were also compared among patients with and without tumor deposits, respectively. Results: Fourteen studies (14) with a total of 18,056 patients were included in the meta-analysis. The calculated incidence of tumor deposits in gastric cancer patients undergoing surgical resection with curative intent was calculated at 17.9%. An increasing prevalence was noted while progressing from T1 to T4 and N0 to N3 stages, respectively. Patients with positive lymphovascular/perineural invasion status and patients with higher tumor grades were also noted to have increased tumor deposit prevalence compared with their negative counterparts. Patients with tumor deposits positive status were found to have an increased hazard ratio for death at the 5-year overall survival mark with a value of 1.308 ( P value < 0.05). A significant degree of heterogeneity was noted across all studies, as well as a significant degree of bias, mainly because all included studies were retrospective in nature. Conclusions: Tumor deposits are a frequent clinical entity in resectable gastric cancer and should systematically be examined in surgical specimens. Their prevalence increases with increasing T, N stages and tumor grade, as well as with positive lymphovascular/perineural invasion status. Tumor deposit positive status appears to impose a worse prognosis for overall survival. Further research is required on the biologic properties of tumor deposits AND on standardization of their identification, especially in the current era of neoadjuvant treatments that are increasingly being utilized. Confirmation of our findings with high-quality prospective data should be another focus of further research.

Background/Objectives: Adenocarcinomas of the esophagogastric and gastric areas are often managed with a multimodal treatment including neoadjuvant chemotherapy and surgery. The impact of neoadjuvant chemotherapy on the host’s antitumoral immune response remains largely unknown. Methods: A retrospective review of a single-institution cohort of patients with adenocarcinoma of the stomach or esophagogastric area undergoing curative intent surgery after neoadjuvant chemotherapy FLOT (Fluorouracil, Leucovorin, Oxaliplatin, Docetaxel) was reviewed. After institutional ethics approval, pathologic slides were re-reviewed and tumor-infiltrating lymphocyte scores were calculated. Tumor-infiltrating lymphocytes (TILs) were studied in conjunction with tumor regression scores (TRG) and the degree of regression in the involved lymph nodes as well as in correlation with the lymph node ratio (the ratio of involved lymph nodes over the total number of lymph nodes resected). Results: A total of 106 patients were reviewed. No statistical correlation could be established between the tumor-infiltrating lymphocyte scores and the degree of regression in the primary tumor as well as with the partial response to chemotherapy of pathologically involved lymph nodes. The TIL score also did not correlate with the lymph node ratio in our patient cohort. A strong correlation was noted between TILs and lymph nodes that completely regressed after neoadjuvant chemotherapy. Conclusions: Tumor-infiltrating lymphocytes do not correlate with the response of the primary tumor or the partial response of the involved lymph nodes, but only with the complete response to neoadjuvant chemotherapy of tumor-involved lymph nodes. Our study focuses on the effects of neoadjuvant chemotherapy on tumor-infiltrating lymphocytes compared to the effects on the primary tumor and the involved lymph nodes.

Incisional hernias represent a far more common complication after midline incisions than previously estimated. Patients with upper gastrointestinal tract malignancies represent a group of patients at increased risk for incisional hernia formation after undergoing major surgery. Our prospectively designed study included 50 patients who underwent onlay synthetic mesh augmentation of their midline closure along with closure using the small bites technique. At a 12-month follow-up, no incisional hernias were documented. A significant decrease compared to historical controls was achieved, with few minor complications. Mesh augmentation of midline closure in patients with upper gastrointestinal tract malignancies can significantly reduce subsequent incisional hernia formation.

Abdominal wall hernias represent a clinical spectrum ranging from a small defect in the abdominal wall causing minimal interruption to patients up to massive defects with severe impairment in abdominal wall function and physiology. Principles of successful hernia repair rely on re-approximation of fascial defect edges to achieve primary closure in a tension free manner and subsequent reenforcement of the repair with a mesh. In the case of large defects, especially in the incisional hernia scenario, advanced fascial release techniques with separation of components is often required to recreate normal anatomy. Relevant techniques are anterior component separation with or without sparing of periumbilical vascular perforators and posterior component separation with transverse abdominis release, representing an expansion of the retrorectus Rives-Stoppa repair. With regards to surgical planning, preoperative imaging, standardization of techniques according to patient and hernia defect characteristics as well as prehabilitation of the abdominal wall with botulinum toxin (chemical component separation) represent significant weapons in the armamentarium of the complex abdominal wall reconstruction surgeon. The scope of this chapter is to attempt to unify pathophysiologic concepts of hernias with anatomic-based advanced repairs.

Background and Objectives: Accurate endoscopic lesion localization is crucial for planning and performing curative-intent surgery in colorectal cancer management. The use of indocyanine green (ICG) has been described as a novel alternative for colorectal lesion marking. Materials and Methods: We have performed a systematic review of the literature on the use of ICG-based tattooing for patients with colorectal cancer undergoing surgery. Results: A total of 19 studies were identified. Seven studies reposted the rates of successful intraoperative localization following ICG tattooing. Additionally, six studies provided detailed descriptions of the administration protocols, including both timing and dosage. A total of twelve studies described the utility of ICG-based tattooing for subsequent lymphadenectomy and its oncologic implications. Lymphadenectomy under fluorescent guidance was associated with increased lymph node yields as well as a change to the surgical lymphadenectomy plan in a significant proportion of patients. Conclusions: ICG-based endoscopic tattooing has demonstrated significant value in facilitating precise lesion localization during curative-intent colorectal surgery. Moreover, its use has been extended to guiding lymphadenectomy, with reports indicating improved lymph node yields. Nevertheless, further research is required to standardize protocols and address existing limitations.