Gastrointestinal cancers in India: Treatment perspective

Nikhil Suresh Ghadyalpatil; Chopra Supriya; Patil Prachi; Dsouza Ashwin; Saklani Avanish

doi:10.4103/2278-330X.187585

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Review Article

05 (

); 126-136

doi:

10.4103/2278-330X.187585

Gastrointestinal cancers in India: Treatment perspective

Nikhil Suresh Ghadyalpatil¹, Chopra Supriya², Patil Prachi³, Dsouza Ashwin⁴, Saklani Avanish^4,

1 Department of Medical Oncology, Yashoda Cancer Institute, Hyderabad, Telangana

2 Department of Radiation Oncology, Tata Memorial Center, Mumbai, Maharashtra

3 Department of Gastroenterology, Tata Memorial Center, Mumbai, Maharashtra

4 Department of GI Surgical Oncology, Tata Memorial Center, Mumbai, Maharashtra

*Corresponding author: Dr. Saklani Avanish. asaklani@hotmail.com

Published: 2020-12-28

MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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Abstract

GI cancer is not one cancer but is a term for the group of cancers that affect the digestive system including gastric cancer (GC), colorectal cancer (CRC), hepatocellular carcinoma (HCC), esophageal cancer (EC), and pancreatic cancer (PC). Overall, the GI cancers are responsible for more cancers and more deaths from cancer than any other organ. 5 year survival of these cancers remains low compared to western world. Unlike the rest of the world where organ based specialities hepatobiliary, pancreatic, colorectal and esophagogastric exist , these cancers are managed in India by either a gastrointestinal surgeons, surgical oncologist, or a general surgeon with varying outcomes.The aim of this review was to collate data on GI cancers in indian continent. In colorectal cancers, data from tertiary care centres identifies the unique problem of mucinous and signet colorectal cancer. Results of rectal cancer resection in terms of technique (intersphincteric resection, extralevator aper, minimal invasive approach ) to be comparable with world literature. However long term outcome and data regarding colon cancers and nationally is needed. Gastric cancer at presentation are advanced and in surgically resected patients, there is need for a trial to compare chemoradiation vs chemotherapy alone to prevent loco regional recurrence. Data on minimal invasive gastric cancer surgery may be sparse for the same reason. Theree is a lot of data on surgical techniques and perioperatve outcomes in pancreatic cancer. There is a high volume of locally advanced gallbladder cancers with efforts on to decide whether neoadjuvant chemotherapy or neoadjuvant chemoradiotherapy is better for down staging. Considering GI cancers, a heterogeneous disease with site specific treatment options and variable outcomes, the overall data and outcomes are extremely variable. Young patients with pathology unique to the Indian subcontinent (for example, signet ring rectal cancer, GBCs) need focussed attention. Solution for such pathology needs to come from the Indian continent itself. Joint efforts to improve outcomes for GI cancer can be integrated under the national cancer grid program.

Keywords

References

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Pai VD, De Souza A, Patil P, Engineer R, Arya S, Saklani A. Intersphincteric resection and hand-sewn coloanal anastomosis for low rectal cancer: Short-term outcomes in the Indian setting. Indian J Gastroenterol 2015;34:23-8.
Shrikhande SV, Bodhankar YD, Suradkar K, Goel M, Shukla PJ. Perioperative outcomes after ultra low anterior resection in the era of neoadjuvant chemoradiotherapy. Indian J Gastroenterol 2013;32:90-7.
Bujko K, Kepka L, Michalski W, Nowacki MP. Does rectal cancer shrinkage induced by preoperative radio (chemo) therapy increase the likelihood of anterior resection? A systematic review of randomised trials. Radiother Oncol 2006;80:4-12.
McCarthy K, Pearson K, Fulton R, Hewitt J. Pre-operative chemoradiation for non-metastatic locally advanced rectal cancer. Cochrane Database Syst Rev 2012;12:CD008368.
Pai VD, Engineer R, Patil PS, Arya S, Desouza AL, Saklani AP. Selective extra levator versus conventional abdomino perineal resection: Experience from a tertiary-care center. J Gastrointest Oncol 2016;7:354-9.
Vallam KC, Desouza A, Bal M, Patil P, Engineer R, Saklani A. Adenocarcinoma of the rectum - A composite of three different subtypes with varying outcomes? Clin Colorectal Cancer 2016;15:e47-52.
Deodhar KK, Budukh A, Ramadwar M, Bal MM, Shrikhande SV. Are we achieving the benchmark of retrieving 12 lymph nodes in colorectal carcinoma specimens? Experience from a tertiary referral center in India and review of literature. Indian J Pathol Microbiol 2012;55:38-42.
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[1] Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136:E359-86.

[2] Pai VD, De Souza A, Patil P, Engineer R, Arya S, Saklani A. Intersphincteric resection and hand-sewn coloanal anastomosis for low rectal cancer: Short-term outcomes in the Indian setting. Indian J Gastroenterol 2015;34:23-8.

[3] Shrikhande SV, Bodhankar YD, Suradkar K, Goel M, Shukla PJ. Perioperative outcomes after ultra low anterior resection in the era of neoadjuvant chemoradiotherapy. Indian J Gastroenterol 2013;32:90-7.

[4] Bujko K, Kepka L, Michalski W, Nowacki MP. Does rectal cancer shrinkage induced by preoperative radio (chemo) therapy increase the likelihood of anterior resection? A systematic review of randomised trials. Radiother Oncol 2006;80:4-12.

[5] McCarthy K, Pearson K, Fulton R, Hewitt J. Pre-operative chemoradiation for non-metastatic locally advanced rectal cancer. Cochrane Database Syst Rev 2012;12:CD008368.

[6] Pai VD, Engineer R, Patil PS, Arya S, Desouza AL, Saklani AP. Selective extra levator versus conventional abdomino perineal resection: Experience from a tertiary-care center. J Gastrointest Oncol 2016;7:354-9.

[7] Vallam KC, Desouza A, Bal M, Patil P, Engineer R, Saklani A. Adenocarcinoma of the rectum - A composite of three different subtypes with varying outcomes? Clin Colorectal Cancer 2016;15:e47-52.

[8] Deodhar KK, Budukh A, Ramadwar M, Bal MM, Shrikhande SV. Are we achieving the benchmark of retrieving 12 lymph nodes in colorectal carcinoma specimens? Experience from a tertiary referral center in India and review of literature. Indian J Pathol Microbiol 2012;55:38-42.

[9] Kim TH, Jeong SY, Choi DH, Kim DY, Jung KH, Moon SH, et al. Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection. Ann Surg Oncol 2008;15:729-37.

[10] Sinukumar S, Engineer R, Saklani A. Preliminary experience with lateral pelvic lymph node dissection in locally advanced rectal cancer. Indian J Gastroenterol 2015;34:320-4.

[11] Gomes RM, Bhandare M, Desouza A, Bal M, Saklani AP. Role of intraoperative frozen section for assessing distal resection margin after anterior resection. Int J Colorectal Dis 2015;30:1081-9.

[12] Maas M, Nelemans PJ, Valentini V, Das P, Rödel C, Kuo LJ, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: A pooled analysis of individual patient data. Lancet Oncol 2010;11:835-44.

[13] Habr-Gama A, Sabbaga J, Gama-Rodrigues J, São Julião GP, Proscurshim I, Bailão Aguilar P, et al. Watch and wait approach following extended neoadjuvant chemoradiation for distal rectal cancer: Are we getting closer to anal cancer management? Dis Colon Rectum 2013;56:1109-17.

[14] Sinukumar S, Patil P, Engineer R, Desouza A, Saklani A. Clinical outcome of patients with complete pathological response to neoadjuvant chemoradiotherapy for locally advanced rectal cancers: The Indian scenario. Gastroenterol Res Pract 2014;2014:867841.

[15] Barreto SG, Chaubal GN, Talole S, DeSouza A, Suradkar K, Gaikwad V, et al. Rectal cancer in young Indians - Are these cancers different compared to their older counterparts? Indian J Gastroenterol 2014;33:146-50.

[16] Ayloor Seshadri R, Kondaveeti SS, Jayanand SB, John A, Rajendranath R, Arumugam V, et al. Complete clinical response to neoadjuvant chemoradiation in rectal cancers: Can surgery be avoided? Hepatogastroenterology 2013;60:410-4.

[17] Vallam KC, Engineer R, Desouza A, Patil P, Saklani A. High nodal positivity rates even in good clinical responders after chemoradiation of rectal cancer: Is organ preservation feasible? Colorectal Dis 2015. Doi:1111/codi.13114. [Epub ahead of print].

[18] Prakash K, Varma D, Rajan M, Kamlesh NP, Zacharias P, Ganesh Narayanan R, et al. Laparoscopic colonic resection for rectosigmoid colonic tumours: A retrospective analysis and comparison with open resection. Indian J Surg 2010;72:318-22.

[19] Seshadri RA, Srinivasan A, Tapkire R, Swaminathan R. Laparoscopic versus open surgery for rectal cancer after neoadjuvant chemoradiation: A matched case-control study of short-term outcomes. Surg Endosc 2012;26:154-61.

[20] Sinukumar S, Menezes JL, Desouza A, Saklani A. Clinical outcomes of patients undergoing laparoscopic vs open surgery for rectal cancers. Gut 2015;64 Suppl 1:A373.3-A374.

[21] Sinukumar S, Mehta S, Ostwal V, Jatal S, Saklani A. Impact of type of surgery (laparoscopic versus open) on the time to initiation of adjuvant chemotherapy in operable rectal cancers. Indian J Gastroenterol 2015;34:310-3.

[22] Prakash K, Kamalesh NP, Pramil K, Vipin IS, Sylesh A, Jacob M. Does case selection and outcome following laparoscopic colorectal resection change after initial learning curve? Analysis of 235 consecutive elective laparoscopic colorectal resections. J Minim Access Surg 2013;9:99-103.

[23] Bertelsen CA, Neuenschwander AU, Jansen JE, Wilhelmsen M, Kirkegaard-Klitbo A, Tenma JR, et al. Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: A retrospective, population-based study. Lancet Oncol 2015;16:161-8.

[24] Engineer R, Basu T, Chopra S, Arya S, Patil P, Mehta S, et al. Factors influencing response to neoadjuvant chemoradiation and outcomes in rectal cancer patients: Tertiary Indian cancer hospital experience. J Gastrointest Oncol 2015;6:155-64.

[25] Engineer R, Mohandas KM, Shukla PJ, Shrikhande SV, Mahantshetty U, Chopra S, et al. Escalated radiation dose alone vs. concurrent chemoradiation for locally advanced and unresectable rectal cancers: Results from phase II randomized study. Int J Colorectal Dis 2013;28:959-66.

[26] Saha A, Ghosh SK, Roy C, Saha ML, Choudhury KB, Chatterjee K. A randomized controlled pilot study to compare capecitabine-oxaliplatin with 5-FU-leucovorin as neoadjuvant concurrent chemoradiation in locally advanced adenocarcinoma of rectum. J Cancer Res Ther 2015;11:88-93.

[27] Sirohi B, Barreto SG, Patkar S, Gupta A, DeSouza A, Talole S, et al. Down-staging following neoadjuvant chemo-radiotherapy for locally advanced rectal cancer: Does timing of surgery really matter? Indian J Med Paediatr Oncol 2014;35:263-6.

[28] Shrikhande SV, Barreto SG, Talole SD, Vinchurkar K, Annaiah S, Suradkar K, et al. D2 lymphadenectomy is not only safe but necessary in the era of neoadjuvant chemotherapy. World J Surg Oncol 2013;11:31.

[29] Hadi R, Mohanti BK, Pathy S, Rath GK, Shukla NK, Deo SV, et al. Gastric cancer: A retrospective analysis from AIIMS, New Delhi. Gulf J Oncolog 2012;(12):11-6.

[30] Chopra S, Agarwal A, Engineer R, Dora T, Thomas B, Sonawone S, et al. Intensity modulated radiation therapy (IMRT) is not superior to three-dimensional conformal radiation (3DCRT) for adjuvant gastric radiation: A matched pair analysis. J Cancer Res Ther 2015;11:623-9.

[31] Sirohi B, Barreto SG, Singh A, Batra S, Mittra A, Rastogia S, et al. Epirubicin, oxaliplatin, and capectabine is just as "MAGIC"al as epirubicin, cisplatin, and fluorouracil perioperative chemotherapy for resectable locally advanced gastro-oesophageal cancer. J Cancer Res Ther 2014;10:866-70.

[32] Sirohi B, Rastogi S, Dawood S, Talole S, Ramadwar M, Shetty N, et al. Treatment of patients with advanced gastric cancer: Experience from an Indian tertiary cancer center. Med Oncol 2014;31:138.

[33] Kurumboor P, Palaniswami KN, Pramil K, George D, Ponnambathayil S, Varma D, et al. Octreotide does not prevent pancreatic fistula following pancreatoduodenectomy in patients with soft pancreas and non-dilated duct: A prospective randomized controlled trial. J Gastrointest Surg 2015;19:2038-44.

[34] D′souza MA, Singh K, Hawaldar RV, Shukla PJ, Shrikhande SV. The vascular stapler in uncinate process division during pancreaticoduodenectomy: Technical considerations and results. Dig Surg 2010;27:175-81.

[35] Sanjay P, Takaori K, Govil S, Shrikhande SV, Windsor JA. ′Artery-first′ approaches to pancreatoduodenectomy. Br J Surg 2012;99:1027-35.

[36] Shrikhande SV, Barreto SG, Bodhankar YD, Suradkar K, Shetty G, Hawaldar R, et al. Superior mesenteric artery first combined with uncinate process approach versus uncinate process first approach in pancreatoduodenectomy: A comparative study evaluating perioperative outcomes. Langenbecks Arch Surg 2011;396:1205-12.

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Gastrointestinal cancers in India: Treatment perspective

Abstract

Abstract

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