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【Objective】 To evaluate the efficacy of ultrasound-guided transperineal puncture and drainage in the treatment of pelvic lymphatic cyst. 【Methods】 A total of 26 patients with pelvic lymphocele who failed with conservative treatment received transperineal puncture and drainage guided by rectal ultrasound. 【Results】 All operations were successful without serious complications. The symptoms in 24 patients relieved within 48 hours after catheter drainage, and 2 patients had the catheter removed after continuous drainage for 3 weeks. Of the 26 patients, 19(73.1%) were cured and 7(26.9%) were relieved. The total effective rate was 100%. 【Conclusion】 Transperineal drainage guided by rectal ultrasound is a safe and effective treatment for pelvic lymphocele.
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Objective To investigate the therapeutic effect and prognostic significance of lateral lymph node dissection (LPLND) in patients with lateral lymph node (LPLN) metastasis. Methods The clinicopathological data of rectal cancer patients who underwent total mesorectal excision (TME) combined with LPLND and pathologically confirmed as LPLN metastasis after operation were retrospectively analyzed. The clinicopathological characteristics and metastasis rules of patients with LPLN metastasis were discussed, and the survival prognosis after LPLND was analyzed. Results A total of 102 rectal cancer patients with pathologically confirmed LPLN metastasis were included. The common sites of LPLN metastasis were internal iliac vessels lymph nodes (n=68, 66.7%), followed by obturator lymph nodes (n=44, 43.1%), and common iliac vessels or external iliac vessels lymph nodes (n=12, 11.8%). There were 10 patients (9.8%) with bilateral LPLN metastases, and the mean number of LPLN metastases was 2.2±2.4, among which 16 patients (15.7%) had LPLN metastases number≥2. The 3-year OS (66.8% vs. 7.7%, P < 0.001) and DFS (39.1% vs. 10.5%, P=0.012) of patients with LPLN metastases to the external iliac or common iliac lymph node were significantly lower than those with metastases to the internal iliac or obturator lymph node. The multivariate analysis showed that LPLN metastasis to external iliac or common iliac lymph node was an independent risk factor both for OS (HR=3.53; 95%CI: 1.50-8.31; P=0.004) and DFS (HR=2.40; 95%CI: 1.05-5.47; P=0.037). Conclusion LPLN mainly metastasizes to the internal iliac or obturator lymph node areas. The survival of patients with metastasis to the external iliac or common iliac lymph node cannot be improved by LPLND, and thus systemic comprehensive treatment is often the optimal treatment option.
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Objective:To compare the pathological results and complications of limited and extended pelvic lymph node dissection among high-risk prostate cancer patients, and to explore the risk factors that affect the rate of lymph node metastasis in high-risk prostate cancer patients.Methods:The data of 800 high-risk prostate cancer patients who underwent radical prostatectomy and pelvic lymph node dissection from January 2016 to December 2020 in three affiliated hospital of Sun Yat-sen University were analyzed retrospectively. According to the scope of pelvic lymph node dissection, they were divided into limited pelvic lymph node dissection (LPLND) group and extended pelvic lymph node dissection (EPLND) group. There were 172 patients underwent LPLND, and 628 patients underwent EPLND.The age of the patients in the LPLND group was 67 (62, 72) years old, diagnosed PSA 20.7 (10.9, 54.8) ng/ml. The biopsy Gleason score 6 in 22 cases, 7 in 59 cases, 8 in 56 cases and 9-10 in 35 cases.The clinical T stage: T 1 in 29 cases, T 2 in 102 cases, T 3 in 37 cases, T 4 in 4 cases; N 0 in 160 cases and N 1 in 12 cases. 50 patients received neoadjuvant hormonal therapy. The age of patients in the EPLND group was 67 (63, 72) years old, diagnosed PSA was 23.9 (14.0, 46.8) ng/ml. Biopsy Gleason Score 6 in 51 cases, 7 in 194 cases, 8 in 218 cases and 9-10 in 165 cases. Clinical T stage: T 1 in 114 cases, T 2 in 341 cases, T 3 in 144 cases, T 4 in 29 cases; N 0 in 526 cases and N 1 in 102 cases.158 patients received neoadjuvant hormonal therapy. There were no significant differences in the age, PSA, puncture Gleason score, clinical T stage, and whether or not to receive neoadjuvant hormonal therapy between the two groups of patients ( P>0.05). The difference in clinical N staging was statistically significant ( P=0.002). The number of postoperative lymph nodes, positive pelvic lymph nodes and postoperative complications and other related clinical and pathological data of the two groups were analyzed. Multivariate logistic regression was used to analyze the risk factors of patients with positive lymph nodes. Results:The median number of lymph nodes harvested [13(8, 19)vs. 6(4, 13), P<0.001] and the rate of positive lymph node cases[31.2%(196/628) vs. 10.5%(18/172), P<0.001] in the EPLND group was significantly higher than those in the LPLND group. Preoperative PSA, clinical N staging, Gleason score, and way of lymph node dissection were independent risk factors for postoperative positive pelvic lymph node in high-risk prostate cancer patients. Compared with the LPLND group, the ELPND group had a higher postoperative complication rate [19.9%(125/628) vs. 11.0%(11/172), P=0.007]. Conclusions:Compared with the LPLND, EPLND in high-risk prostate cancer patients can harvest more lymph nodes and increase the detection rate of positive lymph nodes. The complications of EPLND were higher than those of LPLND. Preoperative PSA, clinical N stage, Gleason score, and the way of lymph node dissection are independent risk factors for positive pelvic lymph node dissection.
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Objective:To improve the rate of successful rescue through analyzing the clinical features and treating processes of septic shock caused by lymphocyst infection after lymph node dissection in diabetic patients.Methods:A total of 462 cases of diabetic patients with bladder, prostate, renal cancers, cervical, endometrial and ovarian were retrospectively analyzed, all of whom underwent standard surgical treatments including pelvic lymph node dissection, hospitalized in department of urology surgery and gynecology of Sun Yat-sen Memorial Hospital from Jan 2015 to Jan 2020. Lymphocytes were confirmed in 148 cases, of which 89 cases were complicated by infection, and 13 cases developed septic shock. Patients with lymphocyst infection were divided into shock and non-shock groups, and age, sex, duration of diabetes, BMI, glycosylated hemoglobin at admission, number of lymph nodes surgically removed, retention time of drainage tube after operation, maximum diameter of lymphocyst and time between infection and previous chemotherapy were compared. The initial symptoms, blood routine in the first time after the onset of the infection, the time from onset to drainage puncture and catheterization and the final outcomes were analyzed in 13 patients with septic shock. The results of pathogen culture and drug sensitivity of infected lymphocyst fluid were also analyzed.Results:Categorical variable test showed that: in diabetic patients with lymphocyst infection, there were significant differences in glycosylated hemoglobin ( P=0.018) , adjuvant chemotherapy ( P=0.014) and lymphocyst size ( P<0.001) between shock group and non-shock group. Among the 13 cases of septic shock, 11 caseshad mild to moderate fever or abdominal pain. The total leukocyte count of all cases in the first hemogram were less than 20×10 9/L. The average time from onset to drainage was 33 hours. Among the 13 patients, 5 developed MODS and 1 died. There were 2 patients whose conditions were complex with frequent fluctuations. In the 12 patients who recovered from septic shock, only 1 underwent a residual lymphocyst pretreatment, 4 had recurrent cyst infection for 1-2 times, 2 had septic shock again, and 1 died. Gram negative bacteria were the most common pathogens, and the main was Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. Piperacillin / tazobactam, carbapenems and tigecycline were commonly sensitive, while the drug resistance rates of ceftazidime, ceftriaxone and levofloxacin were more than 50%. Conclusions:Poor glycemic control, adjuvant chemotherapy and big lymphocyst size(d≥5 cm) are the high risk factors of septic shock. Most of shock patients' initial symptoms and total white blood cell count have no warning significance, leading to longer time from infection to drainage, and delayed treatment. Early diagnosis, timely drainage and active anti-infection treatment are the key to a successful treatment. The possibility of connection between lymphocyst and surrounding organ should be considered when the treatment effect is not good. After septic shock of postoperative lymphocyst infection in patients with diabetes, the larger esidual lymphocyst should be intervened actively to avoid serious infection again.
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Bladder cancer has high morbidity and mortality rates worldwide. Its incidence is high in western countries and has shown an increasing trend in China. While radical cystectomy combined with pelvic lymph node dissection (PLND) is the standard treatment for bladder cancer,the optimal range of PLND remains controversial. In addition,the prognostic value of lymph node factors is also unclear. This article reviews research advances in PLND.
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Humans , China , Lymph Node Excision , Lymph Nodes , Pelvis , Urinary Bladder Neoplasms , DiagnosisABSTRACT
Objective To compare the efficacy of extended pelvic lymph node dissection (ePLND)and oncological outcome by fluorescence laparoscopic radical prostatectomy (FLRP) versus high-definition laparoscopic radical prostatectomy (HD-LRP) for men with locally advanced prostate cancer (LAPCa).Methods In a prospective trial,we recruited 51 patients with T3a-bNxM0 prostate cancer from July 2015 to April 2018.Patients were assigned to study group or control group according to random number method,and were underwent either FLRP + ePLND or HD-LRP + ePLND.21 in the study group were injected with 5 mg of indocyanine green (ICG) into the bilateral lobes of the prostate transperineally guiled by transrectal ultrasound 30 min before surgery for lymphography.During the surgical procedure a fluorescence laparoscope,optimized for detection in the near infrared range,was used to visualize the lymph nodes (green fluorescent) in the dissection region in the study group while a common laparoscopy introduced in control one.Lymph nodes were removed in the external iliac vessiles,internal iliac artery,obturator fossa regions,common iliac regions and presacral regions in both groups.Radical prostatectomy was completed in the both groups by similar steps.The operation time,blood loss,number of removed lymph nodes and positive lymph nodes,complication rate,biochemical recurrence (BCR) and metastasis free survival rates in 2 years were recorded and compared in the two groups.Results 51 eligible patients were selected,including 21 in the study group and 30 in the control group.The mean age of biopsy of study group and control one were (66.4 ± 7.7) and (66.8 ± 7.4),the mean age PSA (23.5 ± 16.8) ng/ml and (26.0 ± 20.1) ng/ml,the mean Gleason score of biopsy (8.1 ± 1.0) and (7.9 ± 0.9) respectively,and there was no statistical significant difference between two groups.The mean operation time of study group and control one were (45.9 ± 4.6) min and (56.4 ± 3.2) min,the mean removed lymph nodes were (27.7 ± 5.6) and (22.1 ±5.6) respectively,and there was statistical significant difference between two groups (all P ＜ 0.05).Lymph nodes invasion in pathology were reported in 8 cases(38.1％)in the study groups while 9 (30.0 ％) in the control one;the proportion of positive lymph node (metastasis) were 3.2％ (19/583) and 3.4％ (23/663) in the two groups respectively and no statistically significant difference was noted between the two groups.Lymphorrhagia occurred in 4 cases in the control group,and there was no serious complications in both groups.The median follow-up time was 20 (7-33) month and during this time,BCR observed of 1 (4.7％) in the study group and 8 (26.7％) in the control;meanwhile,the MFSR was recorded of 100.0％ (0)in the study group and 86.7％ (4)in the control one,showing a statistically significant difference between the two groups(P =0.04).Conclusions Comparing with LRP,FLRP achieved better results of LN dissection,which will improve oncological outcomes.
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Objective To evaluate the clinical efficacy of laparoscopic radical hysterectomy and pelvic lymph node dissection (PLND) in cervical squamous cell carcinoma (CSCC). Methods The clinical data of 83 CSCC patients in our hospital were retrospectively analyzed. The open surgery group (n = 43) underwent traditional transabdominal radical hysterectomy and PLND, while the laparoscopy group (n = 40) underwent laparoscopic radical hysterectomy and PLND. Intraoperative and postoperative indices were compared between the two groups. Results The intraoperative bleeding volume in stage ⅠB1 and ⅡAl patients in the open surgery group was greater than in the laparoscopy group. The operative duration was shorter and fewer lymph nodes were dissected in the open surgery group than in the laparoscopy group (P ＜ 0.05). The time to flatus, fever duration, and hospital stay in stage ⅠB1 and ⅡA1 patients in the open surgery group were longer than in the laparoscopy group (P ＜ 0.05). The frequency of painkiller use in stage ⅡA1 patients in the open surgery group was greater than in the laparoscopy group (P ＜ 0.05). There was no statistical difference in the incidence of intraoperative and postoperative complications between the ⅠB1 and ⅡA1 groups (P＞ 0.05). The physical fitness and social function scores and the adverse effects were significantly different in the open surgery group from those in the laparoscopy group (P ＜ 0.05). Conclusion Laparoscopic radical hysterectomy and PLND for CSCC can reduce intraoperative bleeding volume, increase the number of lymph nodes dissected, shorten the fever duration and hospital stay, and increase the quality of life.
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[Objective] To investigate the safety and efficacy of lateral three layers approach in pelvic lymph node dissection.[Methods] From September 2016 to December 2017,12 patients 7 with bladder cancer,4 with prostate cancer and 1 with penile cancer underwent pelvic lymph node dissection were enrolled.The information of patients,complications,pathologic characteristics,and survival data were analysed.[Results] The patient average age was 60.5 (49～75) years.All operations were successful without conversion to open surgery.The average operation time was 52 (36～79) min,and the bleeding volume was 45 (25～110) mL.The postoperative complications within 30 days,Clavien Ⅰ-Ⅱ were 8 cases,Clavien Ⅲ-Ⅴ were 2 cases.The mean of lymph node dissection was 18.5,and lymph node positive percentage was 25.0％.[Conclusions] The lateral three layers approach in pelvic lymph node dissection was technically feasible.Our data has shown the recent oncological outcome is well.The outcome may need a long-term large sample study to further elaborate.
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Objective To investigate the safety and efficacy of the modified laparoscopic radical cystectomy and standard pelvic lymph node dissection for female bladder cancer patients.Methods Fortyone female patients with bladder cancer who underwent laparoscopic radical cystectomy(LRC) and standard pelvic lymph node dissection(sPLND) in our hospital from June 2003 to January 2016 were retrospectively analyzed.The patients were divided into two groups according to the surgical procedure.There were 15 patients with ≤ cT2 tumor and 1 patient with cT3 in the modified group.The average age was (62.2 ± 11.5) years.The median BMI was 20.7 kg/m2,ranging 18.4 to 22.2 kg/m2;The ASA level was less than Ⅱ in 9 (56.2％) cases and was level Ⅲ in 7 (43.8％) cases.There were 22 patients with ≤ cT2 tumor and 3 patients with cT3 in the traditional group.The average age was (60.4 ± 12.9)years.The median BMI was 21.7 kg/m2,ranging 18.4 to 23.1 kg/m2.ASA was less than level Ⅱ in 15(60.0％) cases and level Ⅲ in 10(40.0％) cases.All operations are performed under general anesthesia.In the traditional group,the plane between rectus and uterus is separated first.Then open the posterior cervical fornix and cut off the lateral bladder pedicle,cardinal ligament of uterus and urethra.The bladder and uterus are removed together.The sPLND is performed at last.In the modified group,the sPLND is performed first.Then separate the bladder and uterus until the anterior wall of the vagina can be exposed.The bladder and uterus are removed separately.Data of the operation and the complications were collected and analyzed.Results All patients were performed the operation successfully.No open conversion was recorded during the operation.No patient died during the peripheral operative phase.In modified group,10 patients received orthotopic ileal neobladder (OIN),5 patients received ileal conduit and 1 patient received ureterostomy.In traditional group,19 patients received OIN,3 patients received ileal conduit and 3 patients received ureterostomy.No significant difference of surgical method was noticed in those group.The median operative time in modified group and traditional group was 290 min (ranging 265-335 min) and 315 min (ranging 270-380 min),respectively(P ＞ 0.05).The median estimated blood loss in modified group and traditional group was 100ml (100,100) and 200ml (200,400),respectively (P ＜ 0.05).The rate of transfusion in modified group and traditional group was 6.3％ (1/16) and 18.5％ (5/27),respectively (P ＜0.05).The incidence of early complications between two groups showed no statistically difference.No major (Clavien grade 3 to 5) complications occurred in modified group.However major complications occurred in 3 patients in traditional group,followed by 2 neobladder vagina fistula,1 ileal anastomotic stoma fistula.All those complications were cured by operation.All patients were diagnosed urothelium carcinoma.In modified group,the tumor stage included carcinoma in suit in 2 cases,pTa-pT1 in 7 cases,pT2 in 6 cases,pT3 in one case.In traditional group,the tumor stage included pT1 in 12 cases,pT2 in 10 cases,pT3 in 3 cases.The numbers of resected lymph node in modified group and conventional group were 16 (ranging 7-19) and 10 (ranging 7-13),respectively (P ＞ 0.05).Conclusions The modified laparoscopic radical cystectomy and pelvic lymph node dissection for female bladder cancer patients could reduce the blood loss and incidence of neobladder vaginal fistula comparing with the traditional operation.
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Objective To evaluate the functional and oncological outcomes of patients with locally advanced prostate cancer (PCa) treated by hormone therapy combined with extra-fascia1 laparoscopic radical prostatectomy (LRP) plus extended lymph node dissection (ePLND).Methods From January 2004 to June 2016,a total of 255 PCa cases (pT3-4NxM0) who received LRP plus ePLND were enrolled into our study.The mean age of the patients was 67 (range 44-88) years,and median PSA level was 21.2 (range 0.6-454.0) ng/ml.The patients were divided into earlier group (from January 2004 to December 2011,160 cases) and later group (from January 2012 to June 2016,95 cases) according to different treatment periods.The baseline demographics between the two groups were similar.All patients routinely received adjuvant hormone therapy (AHT) postoperatively.The patients in the later group underwent collapsin response mediator protein 4 (CRMP4) methylation study on the prostatic biopsy preoperatively.Those with a CRMP4 methylation level ＞ 15％ or rectum/bladder neck invasion,were treated by neoadjuvant hormone therapy (NHT) for 3-6 months.Positive surgical margin (PSM),progression-free survival (PFS),cancer-specific survival (CSS),overall survival (OS) and postoperative continence rates between the two groups were analyzed and compared.Results The mean operative time of the earlier and later group were (239 ±65) min and (203±51) min,mean blood loss were (109-±65) ml and (96-±44) ml,mean dissected nodes were (19 ± 5) and (21 ± 7),respectively (all P ＞ 0.05).The total PSM rate was 19.2％,and PSM rates of the two groups were 23.1％ and 12.6％ (P =0.04).All the 255 cases received AHT and 25 cases in the later group underwent NHT.The median follow-up time was 73 months (range 10-152 months).The total 5-year PFS,CSS and OS rates were 77.7％,94.3％ and 87.1％,respectively,and the rates between groups were 73.8％ vs.86.1％ (P=0.03),93.1％ vs.98.6％ (P=0.07),and 85.0％ vs.92.8％ (P =0.11),respectively.The 1-year postoperative continence rates were 91.9％ vs.97.9％ (P =0.09).Conclusions Hormone therapy combined with LRP plus ePLND represents an oncological and functional effective option in patients with locally advanced PCa,and improved PFS might be acquired by preoperative tumor staging.
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PURPOSE: This study was conducted to evaluate the technical feasibility and safety of robotic extended lateral pelvic lymph node dissection (LPLD) in patients with advanced low rectal cancer. METHODS: A review of a prospectively-collected database at Kyungpook National University Medical Center from January 2011 to November revealed a series of 8 consecutive robotic LPLD cases with a preoperative diagnosis of lateral node metastasis. Data regarding patient demographics, operating time, perioperative blood loss, surgical morbidity, lateral lymph node status, and functional outcome were analyzed. RESULTS: In all eight patients, the procedures were completed without conversion to open surgery. The mean operative time of extended pelvic node dissection was 38 minutes (range, 20 to 51 minutes), the mean number of lateral lymph nodes harvested was 4.1 (range, 1 to 13), and 3 patients (38%) were found to have lymph node metastases. Postoperative mortality and morbidity were 0% and 25%, respectively, but, there was no LPLD-related morbidity. The mean hospital stay was 7.5 days (range, 5 to 12 days). CONCLUSION: Robotic LPLD is safe and feasible, with the advantage of being a minimally invasive approach. Further large-scale studies comparing robotic and conventional surgery with long-term follow-up evaluation are needed to confirm these findings.
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Humans , Academic Medical Centers , Blood Loss, Surgical , Conversion to Open Surgery , Demography , Imidazoles , Length of Stay , Lymph Node Excision , Lymph Nodes , Neoplasm Metastasis , Nitro Compounds , Operative Time , Rectal NeoplasmsABSTRACT
Objective To analyze the effect of individualized care on prevention of postoperative urinary retention of malignancy patients undergoing hysterectomy and pelvic lymph node dissection.Methods 74 cases of patients with malignancies undergoing total hysterectomy and pelvic lymph node dissection in our hospital from June 2009 to December 2011 were chosen as the research object.They were divided into the control group and the observation group with 37 cases in each group.The control group was given traditional routine care,while the observation group was given individualized nursing assessment and intervention.The grasping level of knowledge about prevention of urinary retention,the cooperation degree with nursing,incidence of urinary retention,the residual urine volume and satisfaction degree of patients were analyzed and compared between two groups.Results The grasping level of knowledge about prevention of urinary retention,the cooperation degree with nursing,incidence of urinary retention,the residual urine volume and satisfaction degree of patients in the observation group were better than those of the control group,there were significant differences.Conclusions The effect of individualized care to prevent postoperative urinary retention of malignancies patients after hysterectomy and pelvic lymph node dissection is better.It plays an active role in improving mastering of knowledge about prevention of urinary retention and cooperative degree with nursing.
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Objective To discuss the nursing measures of patients with laparoscopic radical hysterectomy and pelvic lymph node dissection. Methods 24 patients with laparoscopic radical hysterecto my and pelvic lymph node dissection were selected and their perioperative nursing measures were summa rized. Results 24 patients were all cured and discharged, 6 patients accepted chemotherapy and 3 patients accepted radiotherapy. All patients were followed up, and they recovered well. Conclusions Perfect perioperative can guarantee early recovery of patients.
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Objective To discuss the application of pelvic lymph node dissection during radical prostatectomy.Methods The data of 239 patients with prostate cancer which had been done radical prostatectomy and pelvic lymph node dissection were retrospectively reviewed,with the patients'median age of 68 (48-79) years.148 patients(61.9%) had either a Gleason score of>7 or a PSA of>20 ng/ml.All patients were diagnosed as clinical localized prostate cancer preoperatively.The extent of pelvic lymph node dissection included bilateral obturator fossa and region of the external iliac artery.Patients with positive lymph nodes were advised to receive maximal androgen blockade therapy and were followed up until biochemical recurrence.Results It took an average operation time of 20(15-35)min with the average blood loss of 20(5-45) ml for bilateral lymphadenectomy. There was no injury of big vessels and nerves. The total number of lymph node dissected was 1-23 with a median of 7.The median postoperative hospital stay was 16 days.The time of drainage was 4-36 days with a median of 7 days.74.5%(178 cases)of patients had drainage less than 8 days and 9.4%(20 cases)patients were more than 14 days. Positive nodes were found in 29 cases with the positive rate of 12.1%. The median number of positive lymph nodes was 1.Early postoperative complications related to pelvic lymphadenectomy included deep venous thrombosis,lymphocele,lymph leakage,pelvic infection. Patients with positive lymph nodes had a median progression free time of 10 months.Conclusions Pelvic lymph node dissection could detect lymph node metastasis which might be difficult to find through other means. It could facilitate the accurate staging of prostate cancer and bring potential benefits to patients. It does not significantly prolong the operation time and the incidence of complications should decrease gradually with the improvement of the surgeons'experience and surgical techniques.
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Chylous ascites is a disorder caused by various diseases and conditions that interfere with the abdominal or retroperitoneal lymphatics. There are several gynecologic reports on chylous ascites with radiation therapy and para-aortic lymph node dissection. However, the report of chylous ascites caused by performing only pelvic lymph node dissection was extremely rare. In most cases after surgical trauma, it is resolved after dietary managements but it may be associated with serious nutritional and immunologic consequences due to the constant loss of protein and lymphocytes. The authors experienced a 42-year-old woman with cervical cancer Ib1 who presented with chylous ascites after a radical hysterectomy and bilateral pelvic lymph node dissection. She was successfully managed by fasting and low fat diet. We report this case of chylous ascites following pelvic lymph node dissection with a brief review of literature.
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Adult , Female , Humans , Ascites , Chylous Ascites , Diet , Fasting , Hysterectomy , Lymph Node Excision , Lymph Nodes , Lymphocytes , Uterine Cervical NeoplasmsABSTRACT
PURPOSE: One of the most common sites of recurrence after a curative resection of rectal cancer is the pelvis, and local control is a major goal of surgical treatment. The advantages of lateral pelvic lymph node dissection are regarded as questionable because lateral pelvic lymph node metastasis does not occur so frequently and because a lateral lymphadenectomy has a negative influence on the postoperative quality of life. The aim of this study was to clarify if lateral pelvic lymph node dissection (LPLD) conferred any benefit. METHODS: A total of 769 patients who underwent curative surgery for rectal cancer between 1981 and 2005 at the Department of Surgery, OOO Hospital, were reviewed retrospectively. One hundred ninety-three of these patients underwent a lateral pelvic lymph node dissection, and 576 patients had a total mesorectal excision with high ligation of the IMA. RESULTS: There was no difference in pathological characteristics between the two groups. Patients who underwent a lateral pelvic lymph node dissection had no statistically significant difference in terms of the 5-year survival rate at stage II and III (64% vs 65% at stage II, P=0.391; 49% vs 47% at stage III, P=0.815). CONCLUSIONS: A lateral pelvic lymph node dissection has no advantage as part of a standard operation for rectal cancer. A total mesorectal excision alone has good local control and survival compared with a lateral pelvic lymph node dissection.
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Humans , Ligation , Lymph Node Excision , Lymph Nodes , Neoplasm Metastasis , Pelvis , Quality of Life , Rectal Neoplasms , Recurrence , Retrospective Studies , Survival RateABSTRACT
PURPOSE: Diagnostic sampling of pelvic lymph nodes is generally accepted as the optimal procedure for evaluating the metastatic status of locally curable prostate carcinoma. It is usually done by open surgery, but recent developments in laparoscopic surgery have provided another option and are theoretically associated with less trauma and fewer complications than those reported from conventional surgery. We now report our experience, progression and complication of extraperitoneal laparoscopic pelvic lymph node dissection (LPLND). MATERIALS AND METHODS: Between Dec. 1996 and Feb. 1998, 14 patients with high serum PSA (> or = 10 ng/ml) or high Gleason score (> or =5) underwent LPLND before radical perineal prostatectomy. The mean age of 14 patients was 64.46.5 years. The mean of serum PSA level was 51.4+/-39.3 ng/ml, and the mean Gleason score was 7.3+/-1.6. We used balloon dissector for the creation of extraperitoneal space, and perfonned LPLND with a CO2 insufflation through extraperitonium. RESULTS: The average operation time was 138.2+/-29.8 minutes and estimated intraoperative bload loss was 80ml. The Jackson-Pratt drain was removed 3 days postoperatively and the mean drainage volume was 220.5+/-105.2 ml. The average number of dissected nodes was 7.6+/-4.4 (Rt.: 4.1+/-2.9, Lt.: 3.5+/-2.3), and LN metastasis was noted in 4 patients (28.6%). Complications included subcutaneous emphysema (7 patients), peritoneal laceration (3) and obturator nerve injury (1). The mean dissected LN number of the latter 9 cases was 8.6+/-4.8 compared with 6.0+/-3.3 of initial 5 cases, the mean operation time (minute) of the latter 9 cases was 132.8+/-26.6 compared with 148.0+/- 35.8 of initial 5 cases. CONCLUSIONS: The laparoscopic approach can be performed within a resonable time limit and allows adequate assessment of the pelvic lymph node with minimal operative morbidity. Extraperitoneal LPLND is the minimally invasive procedure of choice for the evaluation of patients who are at increased risk of having metastatic pelvic lymph node involvement by prostate cancer.
Subject(s)
Humans , Drainage , Insufflation , Lacerations , Laparoscopy , Lymph Node Excision , Lymph Nodes , Neoplasm Grading , Neoplasm Metastasis , Obturator Nerve , Prostate , Prostatectomy , Prostatic Neoplasms , Subcutaneous EmphysemaABSTRACT
PURPOSE: The status of the pelvic lymph node provides important information with respect to the choice of therapy and prognosis in patients with prostate cancer. we evaluated the clinical effectiveness and safety of laparoscopic pelvic lymph node dissection in 7 patients with prostate cancer. MATERIALS AND METHODS: From July 1996 to December 1997, 7 patients whose mean age was 67.7year (range 56-73) underwent transperitoneal laparoscopic pelvic lymph node dissection as a staging procedure for prostatic cancer. We evaluated the clinical stage, Gleason score, PSA, number of harvested lymph nodes, operative time, postoperative hospital stay, and complications. RESULTS: Clinical stage was T1c-T2c, and mean Gleason score was 7.6(range 6-10). Mean preoperative PSA was 35.3ng/ml(range 19-56.2). The mean number of removed lymph nodes was 8.4(range 5-12) and lymph node metastases were noted in 2 patients. Mean operative time was 180.7minutes (range 140-260). Mean postoperative hospital stay was 2.1 days(range 2-3). Conversion from the laparoscopic procedure to open surgery was not required. Subcutaneous emphysema occurred in 2 patients and was conservatively managed. CONCLUSIONS: Our preliminary experience suggests that laparoscopic pelvic lymph node dissection could be performed safely and efficiently to detect the pelvic lymph node metastasis in patients with prostate cancer with a short hospital stay and a low morbidity, though being more time-consuming.
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Humans , Laparoscopy , Length of Stay , Lymph Node Excision , Lymph Nodes , Neoplasm Grading , Neoplasm Metastasis , Operative Time , Prognosis , Prostate , Prostatic Neoplasms , Subcutaneous EmphysemaABSTRACT
Radical hysterectomy with pelvic lymph node dissection (RHPLD) was considered as primary management of cervical cancer (stage I and IIa). RHPLD provides for resection of paracervical and paravaginal tissues at the lateral pelvic walls, transaction of the uterosacral ligament, ligation of uterine vessels and excision of pelvic lymph node from the surrounding vessels. The urinary tract disturbance was the most frequent and significant postoperative complication. Among 82 patients who had undergone radical hysterectomy with pelvic lymph node dissection for cervical cancer from July 1983 to December 1989, 43 patients who were treated for urologic complications, were reviewed retrospectively. The age distribution was even from 4th to 6th decades. The common urologic complications were neurogenic bladder dysfunction 28 (34.2%). Ureteral injury 15 (18.3% ), UTI 12 (14.6% ), stress incontinence 5 (6.1%). Each urologic complication and its management are discussed.