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Objective: To compare the postoperative function, the short-term and long-term outcomes between fascia-oriented and vascular-oriented lateral lymph node dissection (LLND) in patients with rectal cancer. Methods: A retrospective cohort study was performed. Clinical data of patients who received total mesorectal excision (TME) with LLND at National Cancer Center, Cancer Hospital of Chinese Academy of Medical Science from January 2014 to December 2019 were retrospectively collected. Inclusion criteria were as follows: (1) rectal cancer was pathologically diagnosed, and the lower margin was below the peritoneal reflection. (2) resectable advanced rectal cancer with suspected lateral lymph node metastasis was evaluated based on rectal MRI assessment. (3) preoperative MRI showed lateral lymph node short diameter ≥5 mm and/or lymph node morphology (spike, blur, irregular) as well as heterogenous signal intensity. Lymph node shrinkage was less than 60% after receiving neoadjuvant therapy based on the reassessment of rectal MRI. (4) TME+LLND surgery was performed synchronously. Exclusion criteria were as follows: (1) previous history of pelvic surgery; (2) preoperative cystitis, urethritis, moderate and severe prostatic hyperplasia and other diseases resulting in abnormal urination function; (3) preoperative sexual dysfunction or loss of function; (4) patients receiving LLND due to lateral recurrence after TME; (5) distant metastasis of the tumor at initial diagnosis; (6) Incomplete collection of clinical data. A total of 73 consecutive patients were enrolled in this study. Based on the surgical approaches in performing LLND, patients were divided into fascia-oriented group (n=30) and vascular-oriented group (n=43). There were no significant differences in baseline data between the two groups (all P>0.05). The main outcome indicators of this study were the incidence of postoperative urinary and male sexual dysfunction, the efficacy, the number of lateral lymph nodes harvested and the detection rate of positive lymph nodes. Overall survival (OS) rates and progression free survival (PFS) rates were calculated by the Kaplan-Meier method and compared by log-rank test. Results: All patients in both groups completed surgery successfully. There were no significant differences in operation time, intraoperative blood loss, postoperative complications, and the length of hospital stay between the two groups (all P>0.05). In the whole group, the incidence of postoperative urinary dysfunction and male sexual dysfunction was 43.8% (32/73) and 62.5% (25/40), respectively. The median number of lateral lymph nodes harvested was 8.0(4.0,11.0) with a positive rate of 20.5%(15/73). Compared to the vascular-oriented group, the fascia-oriented group demonstrated a decreased rate of urinary dysfunction [26.7% (8/30) vs. 55.8% (24/43), χ(2)=6.098, P=0.014], lower rate of sexual dysfunction in males [6/15 vs. 76% (19/25), χ(2)=5.184, P=0.023], more harvested lateral lymph nodes [M (P25, P75): 9.5 (6.8, 15.3) vs. 6.0 (3.0, 9.0), Z=-2.849, P=0.004]. There was no significant difference in the positvie rate of lateral lymph nodes between the two groups [20% (6/30) versus 20.9% (9/43), χ(2)=0.009, P=0.923]. Three(4.1%) patients were lost during a median follow-up of 34 (1-66) months. The 3-year PFS and OS of the whole cohort were 69.5% and 88.3%, respectively. No significant difference in 3-year PFS rates (79.6% vs. 62.0%, P=0.172) and 3-year OS rates (91.2% vs. 85.9%, P=0.333) were observed between the fascia-oriented group and the vascular-oriented group (both P>0.05). Conclusion: Fascia-oriented LLND is associated with lower risk of postoperative urinary and male sexual dysfunction in patients with rectal carcinoma, and harvest of more lymph nodes, but no significant advantage in long-term survival.
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Humans , Male , Fascia , Lymph Node Excision , Lymph Nodes , Neoplasm Recurrence, Local , Rectal Neoplasms/surgery , Retrospective Studies , Treatment OutcomeABSTRACT
Objective:To explore the advantage of thyroid biopsy and evaluate detection in the application of thyroid cancer cervical lymph node dissection operation guidance, and provide evidence-based basis for guiding PTC patients whether to receive lateral dissection.Methods:The data of 258 patients with thyroid papillary carcinoma admitted to Department of Thyroid Surgery, Affiliated Hospital of Chengde Medical College from April 2018 to December 2019 were retrospectively analyzed. All patients were admitted to the hospital for ultrasonic examination of cervical lymph nodes. According to the examination results, thyroid biopsy and puncture eluent were performed for patients with suspicious signs of metastasis. Patients with positive test results and with metastatic signs in initial ultrasonic examination received lymph node dissection in the cervical region. All patients underwent pathological examination postoperatively to diagnose the lymph node metastasis, and to evaluate the sensitivity, specificity and accuracy of the detection of the patients with lateral clearance.The measurement data was expressed as mean±standard deviation ( Mean± SD), and the count data was expressed as n(%). The software of SPSS21.0 was used to conduct statistical analysis. Results:All 258 patients were successfully completed the diagnosis of various diagnostic methods. Combined with the postoperative pathological diagnosis results, the accuracy rate of ultrasonic diagnosis of lymph node metastasis was 74.42%, the accuracy rate of FNAC diagnosis was 82.95%, the accuracy rate of FNAC-Tg diagnosis was 87.98%, and the accuracy rate of FNAC-Tg diagnosis was 94.96%. The diagnostic sensitivity of ultrasound, FNAC, FNAC-Tg and FNAC-Tg was 73.60%, 81.72%, 91.01% and 95.83%, respectively, and the diagnostic specificity was 76.25%, 86.11%, 79.71% and 88.41%, respectively. In every four months for a time span since April 2018, the average length of hospital stay for patients with each span was (9.17±1.30), (8.39±1.21), (7.94±1.03), (7.46±0.94), (7.33±0.82) d, their neck area incidence of lymph node metastasis were 17.6%, 21.3%, 15.7%, 12.9%, 11.8%, side clear surgical patients accounted for 42.3%, 37.5%, 30.9%, 26.6%, 19.4%. The incidence of lymph node metastasis was 86.8%, 79.4%, 84.5%, 93.2% and 98.1%, respectively.Conclusion:FNAC-Tg method is used in the diagnosis of thyroid papillary carcinoma patients with high sensitivity and specificity of lymph node metastasis, which has certain value in guiding patients whether to perform lymph node dissection.
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Objective To investigate the feasibility and safety of laparoscopic spleen-preserving splenic hilar lymph nodes dissection through retropancreatic and extruded approach in radical gastrectomy for proximal gastric carcinoma,and to preliminarily analyzed the anatom-ical features.Methods Adopted a retrospective cohort study.The clinical data of 84 patients with proximal gastric carcinoma who underwent radical resection in our hospital from June 2014 to January 2017 were collected.Among the 84 patients,44 case who underwent spleen extru-ded-retroperitoneal approach were regarded as the observation group,and the other 40 patients underwent conventional left approach were allo-cated into the control group.All the patients underwent laparoscopic D 2 radical total gastrectomy and spleen-preserving N0.10 nodes dissec-tion by the same operation team.The clinical situation of the two groups before operation,after operation and during the follow-up were ob-served.Results All the 84 patients successfully completed the radical gastrectomy without conversion to open surgery.In the observation group and the control group,the volume of intraopertative blood loss were respectively(107.9 ±52.9)mL and(153.1 ±72.2)mL;the opera-tion time were respectively(228.8 ±27.7)min and(244.7 ±31.3)min;the number of dissected N0.10 lymph node were respectively(5.0 ± 2.2)and(2.9 ±1.3).There were statistically significant differences in all the above indexs(P<0.05).In the observation group and the control group,the time for initial out-of-bed activity were respectively(1.6 ±0.4)days and(1.5 ±0.4)days;the time of initial anal exsuffla-tion were respectively(2.9 ±0.8)days and(2.6 ±0.5)days;the duration of hospital stay were respectively(7.5 ±1.4)days and(7.0 ± 1.3)days.Postoperative complications occured 4 cases in the observation group and 5 cases in the control group.There was no statistically significant difference in terms of time for initial out-of-bed activity,time of initial anal exsufflation,duration of hospital stay and postoperative complications(P>0.05).A total of 82 patients were followed up for 6 to 36 months,with a median time of 15.5 months.Conclusion Compared with the conventional left approach,laparoscopic spleen-preserving splenic hilar lymph nodes dissection through retropancreatic and extruded approach is safe and feasible for laparoscopic radical resection of proximal gastric carcinoma.And it can shorten the operation time, reduce the volume of intraopertative blood loss,and increase the clearance of N0.10 lymph nodes.
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[Objective]To investigate the value of deep common iliac region lymphadenectomy in treatment of uterine malignancies.[Methods]88 patients with deep common iliac region lymphadenectomy in Third affiliated hospital of sun yat-sen university from March 2016 to June 2017 were enrolled in this study. The number of removed lymph nodes、metastatic lymph nodes、operative complication and so on were analyzed.[Results]The number of pelvic lymph nodes resection is from 18 to 52,the average is 26;the number of deep common iliac region lymph nodes resection is from 2 to 16,the average is 5. The number of pelvic lymph node metastasis is 11 and the rate is 12.5%;the number of deep common iliac region lymph node metastasis is 3,accounting for 27.3% of the total number of pelvic lymph node metasta-sis,which alone deep common iliac region lymph node positive in 1 case,9.0% of the total number of pelvic lymph node metastasis.The average operation time of single pelvic lymph node resection was 43 min and that of single deep common iliac region lymph nodes was 10 min.There was no severe complication.[Conclusion]Deep common iliac region lymphad-enectomy is feasibility and safety,27%of patients with pelvic lymph node metastasis has positive deep common iliac region lymph nodes,and we believe that the promotion and application of deep common iliac region lymphadenectomy can further improve the therapeutic effect of uterine malignancy.
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Objective To investigate the risk factors of hypoparathyroidism after total thyroidectomy and bilateral central lymph node dissection in patients with papillary thyroid carcinoma.Methods Data of patients with PTC who accepted total thyroidectomy and bilateral central lymph node dissection in the Department of Thyroid Surgery from Jan.2013 to Jun.2016 were collected and analyzed retrospectively.The patients were divided into normal group,transient hypoparathyroidism group and permanent hypoparathyroidism group according to the level of serum parathyroid hormone within 6 months after surgery.Clinical data were collected for comparison between the three groups.The risk factors of hypoparathyroidism were indentified with univariate analysis and multivariate analysis.Results A total of 468 patients,241 in the normal group and 227 in the hypoparathyroidism group (220 in the transient hypoparathyroidism group and 7 in the permanent hypoparathyroidism group),were included in the study.Univariate analysis showed that without application of carbon nanoparticles (P=0.04) and autotransplantation of more than one parathyroid gland (P＜0.001) were risk factors of hypoparathyroidism,and without application of carbon nanoparticles (P=0.047),incidental parathyroidectomy of one parathyroid gland (P=0.04),gross extrathyroidal extension (P=0.006) and c N1a were risk factors of permanent hypoparathyroidism.Multivariate analysis showed that without application of carbon nanoparticles (OR,0.437;95％ CI,0.243-0.789;P=0.006) and autotransplantation of more than one parathyroid gland (OR,3.025;95％ CI,1999-4579;,P=0.000) were independent risk fact ors of hypoparathyroidism,and without application of carbon nanoparticles (OR,0.197;95％ CI,0.039-0.982;P=0.048) and gross extrathyroidal extension (OR,12.381;95％ CI,1.432-107.036;P=0.022) were independent risk factors of permanent hypoparathyroidism.Conclusion When total thyroidectomy and bilateral central lymph nodes dissection were performed,carbon nanoparticles were routinely applied.Although autotransplantation of more than one parathyroid gland can increase the incidence of transient hypoparathyroidism,it can reduce the incidence of permanent hypoparathyroidism.If extrathyroidal extension is suspected,hypoparathyroidism should be emphasized to patient,and accurate operation should be done to reduce the incidence of hypoparathyroidism.
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Objective:To determine the value of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) scans in identify-ing the residual retroperitoneal tumor after chemotherapy of testis germ cell tumors. Methods:Sixteen testis germ cell tumor patients with metastasis of retroperitoneal lymph nodes who were treated in our hospital from February 2014 to December 2016 were select-ed for the study from February 2014 to December 2016. After 4-6 cycles of chemotherapy, their CT scans showed residual masses with diameters greater than 2 cm. The retroperitoneal lymph nodes were dissected after the 18F-FDG PET exam. The post-surgery pathology results were compared with the results of the 18F-FDG PET exam. Results:Residual tumors were found in 5 of 10 patients with 18F-FDG PET positive. Residual tumor was absent in 4 of 6 patients with 18F-FDG PET negative, while residual mature teratoma tumors were found in two patients. The accuracy rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the 18F-FDG PET exam were 56.25%(9/16), 71.42%(5/7), 44.44%(4/9), 50.00%(5/10), and 66.67%(4/6), respectively. Conclusion: 18F-FDG PET is highly sensitive. However, many factors influence the result of 18F-FDG PET. Mature teratoma leads to a false negative re-sult, whereas massive tissue inflammation leads to a false positive result. Therefore, more clinical examinations should be made.
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Objective To analyze the safety, feasibility and operative technique details of non-grasping en bloc mediastinal lymph nodes dissection technique in uniportal video-assisted thoracic surgery(VATS) for lung cancer.Methods From April, 2014 to March, 2015,46 patients with lung cancer received non-grasping en bloc mediastinal lymph nodes dissection after uniportal VATS lobectomy.Clinical data of the cases were analyzed retrospectively.There were 19 males and 27 females.The age was(57.2 ± 9.0) (38-73) years.The first 6 cases were performed in the lateral decubitus position while the later 40 cases were all performed in the semiprone position.Results All cases accepted uniportal VATS non-grasping en bloc mediastinal lymph nodes dissection successfully.Arm fatigue of surgeon and assistant was obviously relieved when the patient was placed in the semiprone position.The thoracic drainage time was(3.2 ± 2.1) (1-12)days and the postoperative length of hospital-stay was(6.0 ± 4.5) (2-27) days.The number of dissected mediastinal lymph nodes stations was (4.3 ± 0.8) (3-6)and the number of dissected mediastinal lymph nodes was (11.8 ± 4.9) (4-30).There were 42 cases with stage No , lease wit stage N1, and 3 cases with stage N2 in pathological examination.Five patients developed minor postoperative complications.No perioperative death occurred.Conclusion Uniportal VATS non-grasping en bloc mediastinal lymph nodes dissection for lung cancer was safe and feasible, which could decrease the interference of the instruments and help to keep the surgical field clear.Non-grasping en bloc mediastinal lymph nodes dissection would be performed more smoothly in the semiprone position with less damage to lung and better ergonomics.
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Objective To discuss the significance of region Ⅵ lymph nodes dissection in treatment of patients with clinical cervical nodes negative(cN0)papillary thyroid carcinoma(PTC).Methods Clinical data of 38 cases of cN0 PTC treated with region Ⅵ lymph nodes dissection were retrospectively analyzed.The related literature was reviewed.The cervical nodes dissection scope and the key operation points in treatment of cN0 PTC were discussed.Results No permanent recurrent laryngeal nerve injury or parathyroid damage happened.14 cases(36.84％)had occult lymph node metastasis to region Ⅵ lymph nodes.After more than 5 years of follow-up,all the cases had excellent life quality.3 cases(7.89％)were found lymph node metastasis to lateral cervical region and they were given functional neck dissection.No recurrence or metastasis occurred to the 3 cases during more than 2 years of follow-up.Conclusion Region Ⅵ lymph node dissection in treatment of cN0 PTC is safe,reliable,and with less complications.
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Pathological types of gastric cancer in stage Ⅲ C include T4a-SEN3,T4b-SIN2,T4b-SIN3.Celiac artery metastatic lymphadenopathy fused into blocks,usually from bottom to top.Limited operation space revealed anatomical and pathological factors,the dissection of the celiac artery lymph nodes,processing the left gastric artery root difficulty.Application of novel celiac artery lymph nodes dissection path,avoiding the limitation of the celiac artery lymph node dissection space exposure factors,so that the dissection of the celiac artery lymph nodes is more complete,processing the left gastric artery root easily,reduce the amount of bleeding,shorten operation time,increase the average lymph node dissection and the Ⅲ C gastric cancer resection rate.
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Objective To explore ideal surgical axillary management of early breast cancer,and to determine the feasibility of reducing false negative rate of sentinel lymph node biopsy(SLNB)by combination of axillary suspicious lymph node biopsy and SLNB.Methods From Jan.2008 to Oct.2009,42 consecutive cases with early breast cancer were enrolled.All patients underwent suspicious node hook-wire location by doppler ultrasonography before operation.SLNB and suspicious lymph node biopsy were performed during operation.Complete axillary nodes dissection(ALND)or level II dissection would be conducted according to the biopsy result.The difference of node status prediction between SLNB and SLNB with axillary suspicious lymph node biopsy and was compared.Results All the 42 cases successfully underwent SLNB (100%).There were 2 false negatives occurred in SLNB,resulting in false negative rate of 11%,sensitivity of 88.9%and accuracy of 95.2%in predicting axillary nodes status.By contrast,SLNB with axillary suspicious node biopsy showed a false-negative rate of 0%,sensitivity of 100%,and accuracy of 100%.Conclusions Compared to SLNB in early breast cancer,combination of suspicious node biopsy and SLAB has a tendency of reducing false negative rate.However,Because of the limited samples,the difference has no statistical significance(P=0.2500).
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For more than a century, surgical treatment of gastric cancer is always a subject of debate, es-pecially for the extent of lymph nodes dissection for advanced gastric cancer (AGC). In this article, we re-viewed the advances on lymph node excision in AGC.
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Purpose:To evaluate the efficiency of mediastinal lymph nodes dissection (MLND) and to determine a reasonable extent of dissection in the treatment of patients with clinical stageⅠ A non small cell lung carcinoma (NSCLC). Methods:From January 1988 to June 1995, one hundred and forty seven patients with clinical stageⅠ A NSCLC were treated by surgery. All the patients were divided into three groups according to the type of procedure, that is, resection without MLND, resection with selective MLND and systematic MLND. According to their clinical characteristics patients in each group were matched and assigned once again, and 93 cases were enrolled. Survival rates were calculated by Kaplan meier method and survival curves were prepared and survival difference was compared by Log rank test. Results:Survival rates at 5 year of no MLND, selective MLND and systematic MLND groups were 22.6%, 48.4%, and 51.6%, respectively. Survival rates of two MLND groups were higher than that of no MLND group. Log rank test presented significantly statistical difference between them ( P