Background Standard therapy in gastric or gastro-esophageal junction (GOJ) adenocarcinoma is perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel (FLOT regimen). FLOT offers significant histological response rates. The objective of our study was to evaluate the benefit of postoperative chemotherapy on recurrence free survival (RFS) in operated gastric or gastro-esophageal junction adenocarcinoma ypT0-3N0. Materials and Methods. This retrospective mulicenter study included patients with gastric or GOJ adenocarcinoma ypT0-3N0 treated with preoperative FLOT-type chemotherapy and operated between January 2017 and January 2022. Patients were divided into two groups: a group without postoperative chemotherapy (monitoring group) and a group with postoperative chemotherapy (chemotherapy group). Primary criterion was RFS. Secondary criterion was overall survival (OS). Results A total of 123 patients were included, 107 in the post chemotherapy group and 16 in the monitoring group. Patients in the chemotherapy group were younger (59 vs. 67 years) and had had less preoperative chemotherapy dose reduction (29 vs. 43,7%). There was no significant difference between the 2 groups concerning RFS (p = 0,87) and OS (p = 0,93). Conclusion Our study suggests that postoperative chemotherapy does not improve survival in gastric or GOJ adenocarcinoma following surgery and 4 cycles of preoperative FLOT. Our study paves the way for a prospective randomized trial focusing on the usefulness of 4 cycles of post operative FLOT. Publication type : MeSH : Academic Dissertation

Background and study aims Endoscopic treatment of Zenker’s Diverticulum (ZD) using a flexible endoscope and a diverticuloscope consists of myotomy of the cricopharyngeus muscle, sparing the lower part of the diverticular septum. However, recurrence occurs in up to 54 % of patients at 4 years. We assessed the feasibility and safety of a complete septotomy in endoscopic treatment of ZD. Patients and methods We conducted a retrospective analysis of a prospectively collected database at a single referral center. All consecutive patients treated by complete resection of the diverticular wall were included. The endoscopic technique used a distal attachment cap and division of the ZD septum using a Dual Knife or a Triangle Tip knife in endocut mode, until the esophageal muscularis propria was seen and no residual diverticulum remained. Symptoms were evaluated using the Augsburger questionnaire. Results Nineteen patients, 10 of whom were men with mean age 79 ± 12 years, were treated by complete septotomy for a symptomatic ZD with a median size of 2.5 cm (range 1–5 cm). The clinical success rate was 100 % and the complication rate was 10 % (one pneumonia and one atrial fibrillation). Median hospital stay was 2 days (range 1–3 days). On Day 1 esophagogram, no extraesophageal contrast leakage was seen, periesophageal CO2 was still visible in two patients, and complete ZD regression was seen in 63 % of patients. The 6-month clinical success rate was 100 %, with two patients lost to follow-up, and a median symptom score of 0 (range 0–4). After a mean ± SD follow-up of 9 ± 5 months, the clinical success rate was 94 % (16/17). Conclusion Complete endoscopic septotomy is a feasible and safe therapeutic modality in patients with symptomatic ZD that does not require use of a diverticuloscope, and with good short-term efficacy. The complete regression of the diverticulum observed on Day 1 in 63 % of patients could be a marker of long-term clinical success.