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Context: There is a correlation between prognosis of the colorectal carcinomas and the number of retrieved and metastatic lymph nodes (LNs) from mesentery/mesorectal region. At least 12 LNs must be sampled for accurate evaluation of patients. A number of factors related to surgeon, pathologist, patient and disease could affect the total LN number. For maximizing LN yield, pathologist can use ancillary methods, as fat clearance and special solutions. Aims: This study investigates the effect of second evaluation after ethanol fixation on total and metastatic LN number and assesses factors that influence the dissected LN number. Materials and Methods: 177 colorectal resections were refixed with ethanol for a night, after standard LN sampling. Mesentery/mesorectal tissue was reevaluated for missed LNs. Results were statistically analyzed, P values <0.05 were considered significant. Results: Mean LN number increased from 26 to 30 (median: 20 to 25, P < 0.001) after ethanol fixation. Fourteen cases had additional metastatic LNs after reevaluation of the fat tissue and 5 of them upstaged. 22.5% (44/177) of the patients had <12 LNs before ethanol fixation and this decreased to 14.3% (26/177) after ethanol fixation. Resection type and length, tumor localization, size and histologic degree, pT and neoadjuvant therapy (P < 0.001) had an impact on the LN number (P = 0.034 for histologic degree, P = 0.02 for pT, P < 0.001 for others). Conclusions: Carrying out a second evaluation with ethanol fixation increased total and metastatic LN number and could lead upstage of pN. Ethanol fixation is cost-effective, easy accessible and applicable method; it may improve accuracy of LN assessment and staging, which are important for patients' outcome.
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@#Objective To compare lymph node sampling (LN-S) and lobe-specific lymph node dissection (LSLD) in the clinical efficacy and safety for early-stage non-small cell lung cancer (NSCLC). Methods PubMed, Medline, EMbase, Web of Science and The Cochrane Library databases were searched up to March 2017 for English language studies. We collected randomized controlled trials (RCTs) and cohort studies (CS) which used the systematic mediastinal lymph node dissection (SMLD) and LN-S or L-SLD for the treatment of NSCLC. Direct meta-analysis was performed using RevMan 5.3 software and indirect meta-analysis with ITC software after two researchers screened the literature, extracted the data and evaluated the risk of bias independently. Results A total of 18 articles were included (4 RCTs and 14 CS, and 10 714 patients). Meta-analysis results showed that in the CS, compared with the the SMLD group, overall survival increased in the L-SLD group (HR=0.99, 95%CI 0.78 to 1.25, P=0.92), and overall survival decreased in the LN-S group with significant difference in CS (HR=1.43, 95%CI 1.17 to 1.75, P=0.000 4), but was not statistically significant in RCT (P=0.35). In terms of disease-free survival, there was no significant difference between the SMLD group and the LN-S group (HR=1.25, 95%CI 0.90, 1.62, P=0.10) as well as the L-SLD group (HR=1.15, 95%CI 0.92 to 1.43, P=0.23) in the CS. There was no significant difference in the local recurrence rate or distant metastasis rate between the non-systematic lymph node dissection (NSMLD) and SMLD in CS and RCTs (CS: P=0.43, P=0.39; RCT: P=0.43, P=0.10). There was no significant difference in the postoperative complications between NSMLD and SMLD in the CS (OR=0.79, 95%CI 0.58 to 1.09, P=0.15) and RCTs (OR=0.36, 95%CI 0.09 to 1.45, P=0.15). Indirect meta-analysis showed that risk of death decreased by 31% and risk of recurrence by 35% in the L-SLD group compared with the LN-S group (HR=0.69, 95% CI 0.51 to 0.95, P=0.46; HR=0.65, 95% CI 0.65 to 1.30, P=0.72), but the difference was not statistically significant. Conclusion For earlystage NSCLC, L-SLD is not statistically different from SMLD in terms of survival; however, the overall survival of LN-S is lower than that of systematic lymphadenectomy. Indirect meta-analysis shows that L-SLD reduces the risk of death and recurrence risk compared with LN-S. There is no evidence to support both direct comparison of the prognosis of LN-S and L-SLD, therefore further prospective studies are still needed to verify.
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Objective To explore the influence of different method of mediastinal lymph node excision on the immune function of non-small cell lung cancer patients.Metbods Clinical data was collected continuously from 415 cases of inhospital patients with non-small cell lung cancer from March 2009 to March 2012,who were divided into system lymph node dissection group (SLND,216 cases) and lymph node sampling group (LNS,199 cases).The total lymphocytes,NK cells,CD4+ T cells and CD8+ T cells in blood samples taken preoperatively and at 3rd and 7th day postoperation were analyzed.Results Total lymphocytes,NK cells and CD8+ T cells were reduced significantly in the SLND group compared with those in LNS group at 3rd day and 7th day postoperation (3rd day:LC (0.95±0.57) × 109/L vs (1.10±0.65) × 109/L,CD8+ T cells (19.53± 6.48) ％ vs (20.93±6.70) ％,NK (17.36±6.06) ％ vs (18.57±5.97) ％,P ＜ 0.05; 7th day:LC (0.86±0.53) × 109/L vs (1.00±0.60) × 109/L,CD8+ T cells (17.27±5.64) ％ vs (18.40±5.26) ％,NK (13.11±4.84) ％ vs (14.20± 5.30) ％; P ＜ 0.05).CD4+ T cells in the SLND group were reduced significantly at 3rd day postoperation compared with LNS group ((29.59±6.53) ％ vs (31.19±6.32) ％,P ＜ 0.05).Conclusion LNS can reduce immunosuppression compared with SLND for postoperative patients.
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Objectif : Demontrer l'interet du prelevement ganglionnaire sus-claviculaire et jugulaire inferieur dans la prise en charge des cancers differenties de la thyroide (CDT) N0 clinique. Materiel et methodes : Nous rapportons une etude retrospective a propos de 170 patients colliges sur 12 ans 2005). Tous les patients ont eu une thyroidectomie totale en 1 ou 2 temps. Le curage mediastino-recurrentiel a ete pratique soit systematiquement soit en cas de decouverte d'adenopathies en peroperatoire. Le curage lateral a ete realise soit de principe soit apres un prelevement ganglionnaire sus-claviculaire et jugulaire inferieur positif a l'examen extemporane. Des doses ablatives d'iode radioactif ont ete administrees en cas d'elevation du taux de la thyroglobuline ou d'une fixation d'iode lors du balayage cervico-thoracique. Resultats : L'examen anatomopathologique trouvait un carcinome papillaire (74;1); vesiculaire (16;5) ou papillaire a composante vesiculaire (9;4). Trente patients ont eu un curage fonctionnel systematique uni ou bilateral; une metastase ganglionnaire a ete notee chez 9 d'entre eux. Cent quarante patients ont eu un prelevement ganglionnaire uni ou bilateral; un curage fonctionnel a ete pratique chez 6 d'entre eux devant un examen extemporane positif. Les taux de remission; de recidive et de metastases etaient respectivement de 83;3; 6;7et 10dans le premier groupe; et de 89;3; 4;3et 6;4dans le deuxieme groupe. Par ailleurs; un deces a ete observe chez deux patients du deuxieme groupe (1;4) . Aucune difference statistiquement significative n'a ete retrouvee entre les differents taux. Conclusion : Les resultats de notre serie mettent en evidence l'interet du prelevement sus-claviculaire et jugulaire inferieur permettant d'eviter le curage fonctionnel systematique