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1.
Rev. Assoc. Med. Bras. (1992) ; 68(4): 524-529, Apr. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1376163

ABSTRACT

SUMMARY Objective: Postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) plays an important role in the management of advanced germ cell testicular tumors. Bilateral template lymph node dissection is considered a standard treatment in postchemotherapy residual masses; however, modified unilateral templates have gained acceptance in patients with unilateral residual disease. In this study, we aimed to demonstrate the perioperative and oncological outcomes of the patients with advanced testicular cancer who underwent unilateral modified template PC-RPLND in our center. Methods: This is a retrospective study in which patients who underwent PC-RPLND in a referred center between 2004 and 2021 were investigated. All patients had three or four cycles of chemotherapy and retroperitoneal residual masses. Data were retrospectively collected from medical, operative, radiology, and pathology records and analyzed. Results: A total of 57 patients underwent PC-RPLND. The mean age was 32.7±8.1 years (19-50). According to the disease stage at presentation, there were 39 patients with stage 2 and 18 patients with stage 3. The average tumor size after chemotherapy was 57.6±2.7 mm (25-117). The overall complication rate was 35% (20/57 patients). No grade 4 and 5 complications were observed. Pathologic review demonstrated the presence of teratoma in 28 (49.1%) patients, fibrosis and/or necrosis in 15 (26.3%) patients, and viable germ cell tumor in 14 (24.5%) patients. The mean follow-up was 69.4 months (8-201). During follow-up after surgery, 14 (24.5%) deaths occurred due to advanced disease. Conclusion: PC-RPLND is a major component of the management of advanced testicular germ cell cancer. Our study demonstrated that modified unilateral template is an effective and safe procedure in the postchemotherapy setting for selected patients.

2.
Article in Chinese | WPRIM | ID: wpr-936089

ABSTRACT

Lymphadenectomy, as one of the controversial foci in clinic, is an extremely important part of radical surgery for gastric cancer. So far, the preliminary consensus has been reached on the scope and number of lymph node dissection, based on the etiological mechanism, disease progression, diagnosis and treatment prognosis of gastric cancer. At present, some clinical issues of lymphadenectomy in curative gastrectomy are still need to be addressed. Firstly, standardized procedure in lymph node dissection for gastric cancer is a prerequisite to decrease the incidence of postoperative complications and to improve the prognosis of gastric cancer patients. Furthermore, the plausible treatment strategy in perioperative phase is also deemed as the other key method to offer a benefit of survival rate for advanced stage patients after lymphadenectomy. Last but not least, the technologies for enhancement the prediction accuracy of lymph node metastasis preoperatively or intraoperatively should be worthy in-depth study.


Subject(s)
Gastrectomy/methods , Humans , Lymph Node Excision/methods , Lymphatic Metastasis , Prognosis , Stomach Neoplasms/pathology
3.
Article in Chinese | WPRIM | ID: wpr-936082

ABSTRACT

As a treatment of rectal cancer, lateral lymph node dissection (LLND) is still a controversial issue. The argument against LLND is that the procedure is complicated, and consequently results in a high incidence of postoperative urogenital dysfunction. The surgical modality from fascia to space is adopted by lateral lymph node dissection in "two spaces". This operation has significant advantages of clear location of nerves and blood vessels and simplified surgical procedures, so the surgical procedure can be repeated and modulated. The fascia propria of the rectum, urogenital fascia, vesicohypogastric fascia and parietal fascia constitute the dissection plane for lateral lymph node dissection.Two spaces refer to Latzko's pararectal space and paravesical space. During the establishment of fascia plane, the dissection of external iliac lymph node (No.293), commoniliac lymph node (No.273) and abdominal aortic bifurcation lymph node (No.280) can be performed. While in the "space" dissection, internal iliac lymph node (No.263), obturator lymph node (No.283), lateral sacral lymph node (No.260) and median sacral lymph node (No.270) can be removed. LD2 or LD3 lateral lymph node dissection prescribed by the Japanese Society of Colorectal Cancer can be completed according to the needs of the disease. This article describes the anatomical basis and standardized surgical procedures.


Subject(s)
Dissection , Fascia/pathology , Humans , Lymph Node Excision/methods , Lymph Nodes/pathology , Rectal Neoplasms/surgery
4.
Article in Chinese | WPRIM | ID: wpr-936081

ABSTRACT

Tumor spreading through the lymphatic drainage is an important metastatic pathway for rectum and sigmoid colon carcinoma. Regional lymph node dissection, as an important part of radical resection of colorectal cancer, is the main way for patients with colorectal cancer to achieve radical resection and acquire tumor-free survival. The regional lymph nodes of sigmoid cancer include paracolic lymph nodes, intermediate lymph nodes, and central lymph nodes locating at the root of blood vessel, and radical surgery should include lymph node dissection at the above three stations. The lymphatic pathways of metastasis for rectal cancer include longitudinal metastasis within the mesorectum and lateral metastasis beyond the mesorectum. The standard surgical method of rectal cancer is total mesorectal excision (TME) at present, and the resection range includes the metastatic lymph nodes within the mesorectum through the longitudinal pathway. However, there are many different opinions about lateral lymph node dissection(LLND) aiming at the metastatic lymph nodes locating at the lateral space of rectum. The range of lymph node dissection for rectum and sigmoid cancer is a vital factor that determines the prognosis of patients. Insufficient range of dissection can lead to residual metastatic lymph nodes and have serious impacts on the prognosis of patients. Excessive range of dissection can result in greater surgical trauma, prolonged operation time, more blood loss, and higher rate of complication without oncological benefits. Individualizating the appropriate resection range of rectum and sigmoid colon cancer on the basis of standardization and according to the clinical stage and invasion range of tumor demonstrates great significance of ensuring the radical operation, reducing trauma, promoting rehabilitation, protecting the function and improving the prognosis.


Subject(s)
Humans , Lymph Node Excision/methods , Lymph Nodes/pathology , Rectal Neoplasms/pathology , Rectum/pathology , Reference Standards , Sigmoid Neoplasms/surgery
5.
Article in Chinese | WPRIM | ID: wpr-936079

ABSTRACT

Splenic flexure colon cancer occurs at a relatively lower rate than colon cancer of other sites. It is also associated with more advanced disease and higher rate of acute obstruction. The splenic flexure receives blood supply from both superior and inferior mesenteric arteries (SMA and IMA), and therefore has lymphatic drainage to both areas. The blood supply is also highly variable, causing difficulties in determining the main feeding vessels and the main direction of lymph drainage. Few studies with limited cases focused on this specific tumor site with respect to the patterns of lymph node spread, especially the main lymph node status and the value of its dissection. The lack of information limits the development of a consensus on the extent of surgical resection and lymphadenectomy. Adequate mobilization of the colon facilitates a sufficient length of bowel resection and the high ligation of feeding arteries from both SMA and IMA. Further evidence on the chnoice of procedures and the extent of lymph node dissection need multicenter collaboration, with the use of modern techniques, including CT 3D reconstruction of the colon and angiography, as well as intraoperative fluorescent real-time imaging of lymph nodes.


Subject(s)
Colon, Transverse/surgery , Colonic Neoplasms/surgery , Humans , Laparoscopy , Lymph Node Excision/methods , Lymph Nodes/pathology , Mesenteric Artery, Inferior/surgery
6.
Article in Chinese | WPRIM | ID: wpr-936077

ABSTRACT

There are still controversies as to the location of ligating the inferior mesenteric artery and the central lymph node dissection during rectal cancer surgery. The reason is that the level of evidence in this area is low. Existing studies are mostly retrospective, analyses or small-sample randomized controlled trials. These results showed no significant differences between high-ligation and low-ligation, in terms of anastomotic leakage and other short-term postoperative complications. Low-ligation seems better for the recovery of postoperative genitourinary function. Due to the low rate of central lymph node metastasis and many other confounding factors that affect the survival rate, it is difficult to conclude the survival benefits of ligation site or central node dissection. It is necessary to carry out some targeted, well-designed, large-scale randomized controlled trials to explain the related issues of inferior mesenteric artery ligation site and extent of central lymphadenectomy.


Subject(s)
Humans , Laparoscopy/methods , Ligation/methods , Lymph Node Excision/methods , Mesenteric Artery, Inferior/surgery , Mesentery , Rectal Neoplasms , Rectum/surgery , Retrospective Studies
7.
Article in Chinese | WPRIM | ID: wpr-936051

ABSTRACT

A greater controversy remains in clinical diagnosis and treatment of Siewert type II adenocarcinoma of esophagogastric junction (AEG), compared with Siewert type I and III AEG. In 2018, the first edition of Chinese Expert Consensus on the Surgical Treatment for Adenocarcinoma of Esophagogastric Junction was published in the Chinese Journal of Gastrointestinal Surgery. In the past few years, the advance in minimally invasive thoracoscopic surgery has been proven to reduce thoracic trauma in Siewert type II AEG. Meanwhile, distal thoracic esophagectomy can achieve more complete resection, and upper abdomen-right thoracic approach can ensure the mediastinal lymph node dissection and improve long-term survival. The concept and practice of endoscopic surgery and the comprehensive treatment also give new supplements to the treatment regimen of Siewert type II AEG. More clinical researches should be conducted to address the surgical residual safety and lymph node dissection issues.


Subject(s)
Adenocarcinoma/pathology , Esophageal Neoplasms/surgery , Esophagogastric Junction/surgery , Gastrectomy , Humans , Lymph Node Excision , Retrospective Studies , Stomach Neoplasms/surgery , Thoracic Surgery
8.
Chinese Journal of Oncology ; (12): 446-449, 2022.
Article in Chinese | WPRIM | ID: wpr-935235

ABSTRACT

Objective: To evaluate the indications, safety, feasibility, and surgical technique for patients with head and neck cancers undergoing transoral robotic retropharyngeal lymph node (RPLN) dissection. Methods: The current study enrolled 12 consecutive head and neck cancer patients (seven males and four females) who underwent transoral robotic RPLN dissection with the da Vinci surgical robotic system at the Sun Yat-sen University Cancer Center from May 2019 to July 2020. Seven patients were diagnosed as nasopharyngeal carcinoma with RPLN metastasis after initial treatments, 4 patients were diagnosed as thyroid carcinoma with RPLN metastasis after initial treatments, and one patient was diagnosed as oropharyngeal carcinoma with RPLN metastasis before initial treatments. The operation procedure and duration time, intraoperative blood loss volume and complications, nasogastric feeding tube dependence, tracheostomy dependence, postoperative complications, and hospitalization time were recorded and analyzed. Results: All patients were successfully treated by transoral robotic dissection of the metastatic RPLNs, none of which was converted to open surgery. RPLNs were completely resected in 10 patients, and partly resected in 2 patients (both were nasopharyngeal carcinoma patients). The mean number of RPLN dissected was 1.7. The operation duration time and intraoperative blood loss volume were (191.3±101.1) min and (150.0±86.6) ml, respectively. There was no severe intraoperative complication such as massive haemorrhage or adjacent organ injury during surgery. Nasogastric tube use was required in all patients with (17.1±10.6) days of dependence, while tracheotomy was performed in 8 patients with (11.6±10.7) days of dependence. The postoperative hospitalization stay was (8.5±5.7) days. Postoperative complications occurred in 4 patients, including 2 of retropharyngeal incision and 2 of dysphagia. During a follow-up of (6.5±5.1) months, disease-free progression was observed in all patients, 10 patients were disease-free survival and other 2 patients were survival with tumor burden. Conclusions: The transoral robotic RPLN dissection is safety and feasible. Compared with the traditional open surgical approach, it is less traumatic and safer, has fewer complications and good clinical application potentiality. The indications for transoral robotic RPLN dissection include thyroid carcinoma, oropharyngeal carcinoma, and some selected nasopharyngeal carcinoma and other head and neck cancers. Metastatic RPLNs from some nasopharyngeal carcinoma with incomplete capsule, unclear border and adhesion to the surrounding vessels are not suitable for transoral robotic RPLN dissection.


Subject(s)
Blood Loss, Surgical , Female , Head and Neck Neoplasms/pathology , Humans , Lymph Node Excision/methods , Lymph Nodes/pathology , Male , Nasopharyngeal Carcinoma/pathology , Nasopharyngeal Neoplasms/surgery , Neck Dissection/methods , Postoperative Complications/surgery , Robotic Surgical Procedures/methods , Thyroid Neoplasms/pathology
9.
Chinese Journal of Oncology ; (12): 430-435, 2022.
Article in Chinese | WPRIM | ID: wpr-935232

ABSTRACT

Objective: To evaluate the feasibility of identification and preservation of arm lymphatics (DEPART) in axillary lymph node dissection (ALND) for breast cancer to prevent arm lymphedema. Methods: A randomized controlled study method was used. Two hundred and sixty-five patients who underwent breast cancer surgery at the Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University from November 2017 to June 2018 were included, and the patients were randomly divided into ALND+ DEPART group (132 patients) and standard ALND group (133 patients) by random number table method. In the ALND+ DEPART group, indocyanine green and methylene blue were injected as tracers before surgery, and the arm sentinel nodes was visualized by staged tracing during intraoperative dissection of axillary lymph nodes. Partial frozen sections were made of arm lymph nodes >1 cm in length and hard and suspicious of metastasis, and arm lymph nodes and lymphatic vessels were selectively preserved. Patients in the standard ALND group underwent standard ALND. Objective and subjective indexes of arm lymphedema were evaluated by 5-point circumference measurement and Norman questionnaire. Results: Among 132 breast cancer patients in the ALND+ DEPART group, 121 (91.7%) completed DEPART. There were no statistically significant differences in age, body mass index, pathological type, dissection number of axillary lymph node, N stage, TNM stage, molecular typing, and regional radiotherapy between the ALND+ DEPART and standard ALND groups (P>0.05). At a median follow-up of 24 months, assessment by the 5-point circumference measurement showed that the incidence rates of lymphedema in the ALND+ DEPART and standard ALND groups were 5.0% (6/121) and 15.8% (21/133), respectively, with statistically significant differences (P=0.005). Assessment by the Norman questionnaire showed that the incidence rates of lymphedema in the ALND+ DEPART and standard ALND groups were 5.8% (7/121) and 21.8% (29/133), respectively, with a statistically significant difference (P<0.001). No local regional recurrence was observed in either group during the follow-up period. Conclusion: For breast cancer patients with positive axillary lymph nodes, the administration of DEPART during ALND can reduce or avoid the occurrence of arm lymphedema without compromising oncology safety.


Subject(s)
Arm/pathology , Axilla/pathology , Breast Neoplasms/pathology , Female , Humans , Lymph Node Excision/methods , Lymph Nodes/surgery , Lymphatic Vessels/pathology , Lymphedema/surgery , Sentinel Lymph Node Biopsy/adverse effects
10.
Chinese Journal of Urology ; (12): 17-22, 2022.
Article in Chinese | WPRIM | ID: wpr-933155

ABSTRACT

Objective:To identify preoperative clinical predictors of positive lymph nodes in patients with renal cell carcinoma (RCC)and provide a preoperative predictive model.Methods:The data of 173 RCC patients who underwent either retroperitoneal lymph node dissection or biopsy at a single institution from January 2016 to December 2020 were retrospectively analyzed. There were 109 males and 64 females, with an average age of (53.29±13.58) years, median tumor diameter of 70 (23-150) mm, 68 patients with local symptoms, 24 patients with systemic symptoms, and 56 patients with ECOG score ≥1. There were 96 patients with tumor pseudocapsule, 23 patients with renal vein or inferior vena cava tumor thrombus, 114 patients in stage T 1-2, 59 patients in stage T 3-4, 22 patients with distant metastasis and 88 patients with lymph node metastasis by preoperative imaging examination. Univariate analysis was performed by Mann-Whitney U test or Chi-square test, and multivariate logistic regression analysis was used to determine preoperative predictors of pathologic lymph node positivity. The significant variables were then included in a novel Nomogram to predict the probability of lymph node invasion.C-index and Bootstrap self-sampling methods were used to evaluate the discrimination and consistency of the model. Results:Of the 173 patients, 49(28.32%)and 124(71.68%)had pN 1 and pN 0 disease, respectively. Among 88 patients with suspected lymph node involvement (cN 1) assessed by preoperative imaging, only 47.73%(42/88) were confirmed to be pathologically positive. However, 8.24% (7/85) of the 85 patients with negative lymph nodes (cN 0) assessed by preoperative imaging were pathologically positive. Age, ECOG score, symptoms at presentation, tumor pseudocapsule, metastasis at diagnosis, clinical tumor stage, clinical nodal status, clinical nodal size, D-dimer, lactate dehydrogenase, microscopic hematuria were significant in the univariate analysis ( P<0.05). On multivariable analyses, the most informative independent predictors were age, clinical tumor stage, clinical nodal status, clinical nodal size and microscopic hematuria ( P<0.05). A Nomogram with good performance was developed to predict the probability of lymph node metastasis. The C-index of the model was 0.954, the calibration curve of forecasting curve with the ideal curve fit was good, indicating that the model has a good consistency. Conclusions:Younger age, microscopic hematuria, suspected lymph node involvement in imaging, larger lymph node diameter and higher T stage were independent risk factors for renal cell carcinoma with lymph node metastasis. The Nomogram based on the above factors has good identification and calibration ability, which can help predict the probability of lymph node metastasis of renal cell carcinoma before surgery.

11.
Article in Chinese | WPRIM | ID: wpr-932762

ABSTRACT

Objective:To evaluate the clinical value of lymph node dissection (LND) for intrahepatic cholangiocarcinoma (ICC) after surgical resection.Methods:A retrospective study was conducted on the clinical data of 156 patients who underwent surgery for ICC in Eastern Hepatobiliary Surgery Hospital of Naval Military Medical University from November 2010 to December 2017, including 94 males and 62 females, aged (60.0±9.5) years. Curative surgery was performed in 114 cases. Of 64 cases were in stage Ⅰ according to American Joint Committee on Cancer (AJCC), including 38 cases of non-lymph node dissection (NLND) and 26 cases of LND; 21 cases were in AJCC stage Ⅱ, including 11 cases of NLND and 10 cases of LND; 22 cases were in AJCC stage Ⅲb, including 14 cases of LND and 8 cases of lymph node resection (LNR); 5 cases were in AJCC stage Ⅲa, 2 cases were in AJCC stage Ⅳ. Univariate and multivariate Cox regression analysis were used for the risk factors of ICC prognosis. The log-rank test compared the survival rates of the two groups.Results:Cox multivariate analysis indicated that lymph node metastasis was independent risk factors for prognosis in patients with ICC ( HR=1.96, 95% CI: 1.09-3.55, P=0.026). A total of 114 patients were included in the curative surgery group. The 1-, 3-, and 5-year overall survival (OS) rates of the negative lymph node group ( n=91) were 65.9%, 47.3% and 35.6%, respectively, which were significantly better than those of the positive lymph node group ( n=23) who had 1-, 3-, 5-year OS rates of 56.5%, 17.7% and 0, respectively (χ 2=8.11, P=0.004 ). In stage Ⅰ and Ⅱ patients, there were no significant differences in 1-, 3-, 5-year OS rates between the NLND group and the LND group (both P>0.05 ). In stage Ⅲb patients, the LND group had 1-, 3-, 5-year OS rates of 71.4%, 29.8% and 0, respectively, significantly better than those of the LNR group who had 1-, 3-, 5-year OS rates of 37.5%, 0 and 0, respectively (χ 2=6.45, P=0.011). Conclusions:Lymph node metastasis is an independent risk factor affecting the prognosis of ICC. Lymph node dissection should be performed cautiously in ICC with AJCC stage Ⅰ and Ⅱ, while routine lymph node dissection is recommended in ICC with AJCC stage Ⅲb.

12.
Article in Chinese | WPRIM | ID: wpr-930962

ABSTRACT

Objective:To investigate the clinical efficacy of pancreaticoduodenectomy with TRIANGLE operation in the treatment of pancreatic head cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 51 patients with pancreatic head cancer who were admitted to the Sichuan Provincial People′s Hospital, Affiliated Hospital of School of Medicine of University of Electronic Science and Technology of China from January 2017 to July 2018 were collected. There were 33 males and 18 females, aged from 42 to 74 years, with a median age of 56 years. Of the 51 patients, 24 cases undergoing standard pancreaticoduodenectomy, in which No.12, 13 and 17 lymph nodes were dissected, combined with transcatheter arterial infusion chemo-therapy (TAI) were allocated into the standard group, and 27 cases undergoing pancreaticoduo-denectomy with TRIANGLE operation, in which No.7, 8, 9, 12, 13, 16, 17 lymph nodes were dissected, combined with TAI were allocated into the TRIANGLE group, respectively. Observation indicators: (1) intraoperative conditions of the two groups; (2) postoperative conditions of the two groups; (3) follow-up and survival. Follow-up was conducted using outpatient examination and telephone interview once three months to detect tumor recurrence and metastasis and survival of patients up to July 2021 or the death of patient. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was analyzed using the chi-square test or the Fisher exact probability. Comparison of ordinal data was analyzed using the rank sum test. Kaplan‐Meier method was used to calculate the survival rate and median survival time and draw survival curve. Log‐Rank test was used for survival analysis. Results:(1) Comparison of intraoperative conditions between the two groups. The operation time, volume of intraoperative blood loss, cases with intraoperative blood transfusion were (501±61)minutes, (563±278)mL, 4 in the standard group, versus (556±46)minutes, (489±234)mL, 6 in the TRIANGLE group, respectively. There was a significant difference in the operation time between the two groups ( t=3.62, P<0.05) but there was no significant difference in the volume of intraoperative blood loss or cases with intraoperative blood transfusion between the two groups ( t=1.03, χ2=0.25, P>0.05). (2) Comparison of postoperative conditions between the two groups. Of the 51 patients, 30 had 50 times of postoperative complications, including 18 times of grade Ⅰ complications of Clavien-Dindo classification, 29 times of grade Ⅱ complications of Clavien-Dindo classification, 2 times of grade Ⅲa complications of Clavien-Dindo classification, 1 time of grade Ⅲb complications of Clavien-Dindo classification, respectively. Cases with postoperative complications, cases with delayed gastric emptying, cases without or with pancreatic fistula as class A or class B, cases with biliary fistula, cases with bleeding, cases with diarrhea were 15, 4, 13, 7, 4, 4, 2, 2 in the standard group, versus 15, 6, 14, 10, 3, 4, 1, 3 in the TRIANGLE group, respectively. There was no significant difference in cases with postoperative complications, cases with delayed gastric emptying, cases with pancreatic fistula between the two groups ( χ2=0.16, 0.02, Z=-0.04, P>0.05) and there was no significant difference in cases with biliary fistula, cases with bleeding, cases with diarrhea between the two groups ( P>0.05). Cases with complications as Clavien-Dindo grade Ⅰ, grade Ⅱ, grade Ⅲ were 10, 11, 2 in the standard group, versus 8, 18, 1 in the TRIANGLE group, showing no significant difference between the two groups ( Z=-0.67, P>0.05). The duration of postoperative hospital stay was (23±8)days in both of the standard group and the TRIANGLE group, showing no significant difference between the two groups ( t=0.31, P>0.05). (3) Follow-up and survival. All the 51 patients were followed-up for 6 to 54 months, with a median follow-up time of 17 months. The postoperative 1-year overall survival rate was 75.0% and 81.5% in the standard group and the TRIANGLE group, respectively. The postoperative 3-year overall survival rate was 12.5% and 22.2% in the standard group and the TRIANGLE group, respectively. The median postoperative survival time was 15.00 months (95% confidence interval as 12.63 to 17.37 months) and 21.00 months (95% confidence interval as 15.91 to 19.62 months) in the standard group and the TRIANGLE group, respectively. There was a significant difference in survival of patients between the two groups ( χ2=4.30, P<0.05). Cases with tumor recurrence during post-operative 1 year and 3 year were 9 and 20 in the standard group, versus 6 and 15 in the TRIANGLE group, respectively. There was no significant difference in cases with tumor recurrence during postoperative 1 year between the two groups ( P>0.05) and there was a significant difference in cases with tumor recurrence during postoperative 3 year between the two groups ( P<0.05). Conclusion:Compared with standard pancreaticoduodenectomy, pancreaticoduodenectomy with TRIANGLE operation can prolong the median survival time of patients with pancreatic head cancer without increasing surgical related complications.

13.
Article in Chinese | WPRIM | ID: wpr-930944

ABSTRACT

Since the first report of robotic surgical system in gastric cancer by Hashizume in 2002, the new generation of minimally invasive technology represented by robotic surgical system has developed rapidly in gastric cancer. The new generation of minimally invasive technology is cha-racterized by faster recovery of patients, better of clinical outcomes and long-term efficacy. In the past 20 years, robotic surgical system has made great progress in clinical application, which is expected to solve the disadvantages and problems of laparoscopic surgery. Experienced surgeon teams have accumulated lots of research experiences in clinical application of robotic surgical system. Robotic surgical system can provide a technologically superior surgical environment for minimally invasive surgery, which could be an effective and feasible alternative to conventional radical gastrectomy. The author investigates the hot issues of robotic radical gastrectomy including the feasibility, safety, short- and long-term outcome and current research status.

14.
Article in Chinese | WPRIM | ID: wpr-930903

ABSTRACT

Esophageal cancer is one of the common malignant tumors in the worldwide and has regional characteristics in China. At present, the treatment of esophageal cancer is still a comprehensive diagnosis and treatment mode based on surgery. With the application of minimally invasive technique in surgery of esophageal cancer, the concept of surgical diagnosis and treatment for esophageal cancer is constantly updating. The application of robotic surgical system in esophageal surgery promotes the surgical quality of lymph node dissection and improves the technique of intraluminal anastomosis under total endoscopy. For locally advanced esophageal cancer, a diagnosis and treatment mode based on neoadjuvant therapy has been gradually accepted by most of doctors around China. Combined with the latest researches at home and abroad, the authors investigate the development of surgical techniques, the renewal of surgical concept and the changes on diagnosis and treatment, summarize the new advances in comprehensive surgical treatment for esophageal cancer, in order to provide the theoretical guidance for the standardized treatment of esophageal cancer.

15.
International Journal of Surgery ; (12): 294-298, 2022.
Article in Chinese | WPRIM | ID: wpr-930012

ABSTRACT

Gastric cancer is one of the most common malignant tumors, which seriously threatens people's life and health with high morbidity and mortality. Operation-centered comprehensive therapy is the most vital method for treating gastric cancer.With the development of surgical concepts, science and technology, as well as the development of a large number of high-standard clinical studies, the treatment of gastric cancer has made great progress, and the surgical method has gradually changed from open surgery to minimally invasive surgery.The research focus of early gastric cancer is to protect function and reduce trauma.Consensus has also been reached on the scope of lymph node dissection for locally advanced gastric cancer, and minimally invasive surgical methods have achieved certain results in terms of safety and effectiveness.For advanced gastric cancer with only one incurable factor, aggressive surgical treatment can also achieve good results.In recent years, high-definition laparoscopy, 3D laparoscopy, fluorescent laparoscopy, surgical robots and artificial intelligence have all promoted the development of gastric cancer diagnosis and treatment technology.This paper reviews the current surgical treatment of gastric cancer in order to better guide clinical treatment and benefit patients.

16.
Asian Journal of Andrology ; (6): 97-101, 2022.
Article in English | WPRIM | ID: wpr-928516

ABSTRACT

To efficiently remove all recurrent lymph nodes (rLNs) and minimize complications, we developed a combination approach that consisted of 68Gallium prostate-specific membrane antigen (PSMA) ligand positron emission tomography (PET)/computed tomography (CT) and integrated indocyanine green (ICG)-guided salvage lymph node dissection (sLND) for rLNs after radical prostatectomy (RP). Nineteen patients were enrolled to receive such treatment. 68Ga-PSMA ligand PET/CT was used to identify rLNs, and 5 mg of ICG was injected into the space between the rectum and bladder before surgery. Fluorescent laparoscopy was used to perform sLND. While extensive LN dissection was performed at level I, another 5 mg of ICG was injected via the intravenous route to intensify the fluorescent signal, and laparoscopy was introduced to intensively target stained LNs along levels I and II, specifically around suspicious LNs, with 68Ga-PSMA ligand PET/CT. Next, both lateral peritonea were exposed longitudinally to facilitate the removal of fluorescently stained LNs at levels III and IV. In total, pathological analysis confirmed that 42 nodes were rLNs. Among 145 positive LNs stained with ICG, 24 suspicious LNs identified with 68Ga-PSMA ligand PET/CT were included. The sensitivity and specificity of 68Ga-PSMA ligand PET/CT for detecting rLNs were 42.9% and 96.6%, respectively. For ICG, the sensitivity was 92.8% and the specificity was 39.1%. At a median follow-up of 15 (interquartile range [IQR]: 6-31) months, 15 patients experienced complete biochemical remission (BR, prostate-specific antigen [PSA] <0.2 ng ml-1), and 4 patients had a decline in the PSA level, but it remained >0.2 ng ml-1. Therefore, 68Ga-PSMA ligand PET/CT integrating ICG-guided sLND provides efficient sLND with few complications for patients with rLNs after RP.


Subject(s)
Gallium Isotopes , Gallium Radioisotopes , Humans , Indocyanine Green , Ligands , Lymph Node Excision , Lymphatic Metastasis/diagnostic imaging , Male , Neoplasm Recurrence, Local/surgery , Positron Emission Tomography Computed Tomography , Prostate , Prostatectomy , Prostatic Neoplasms/surgery , Salvage Therapy
17.
Article in Chinese | WPRIM | ID: wpr-923439

ABSTRACT

@#Objective    To compare the postoperative chylothorax outcomes of robot-assisted thoracic surgery (RATS) and video-assisted thoracoscopic surgery (VATS), analyze the risk factors for postoperative chylothorax after minimally invasive radical lung cancer resection and explore possible prevention and control measures. Methods    Between June 2012 and September 2020, 1 083 patients underwent minimally invasive pulmonary lobectomy and systematic lymph node dissection in our hospital, including 578 males and 505 females with an average age of 60.6±9.4 years. Patients were divided into two groups according to the operation methods: a RATS group (499 patients) and a VATS group (584 patients). After propensity score matching, 434 patients were included in each group (868 patients in total). Chylothorax and other perioperative indicators were compared between the two groups. Univariate and multivariate logistic regression analyses were performed to identify risk factors for postoperative chylothorax. Results    Overall, 24 patients were diagnosed with chylothorax after surgery. Compared with the VATS group, the rate of chylothorax was higher (3.9% vs. 1.6%, P=0.038), the groups and numbers of dissected lymph nodes were more (both P<0.001), and the intraoperative blood loss was significantly less (P<0.001) in the RATS group. There was no statistical difference in the postoperative hospital stay (P=0.256) or chest tube drainage time (P=0.504) between the two groups. Univariate analysis showed that gender (P=0.021), operation approach (P=0.045), smoking (P=0.001) and the groups of dissected lymph nodes (P<0.001) were significantly associated with the development of chylothorax. Multivariate analysis showed that smoking [OR=4.344, 95%CI (1.149, 16.417), P=0.030] and the groups of dissected lymph nodes [OR=1.680, 95%CI (1.221, 2.311), P=0.001] were the independent risk factors for postoperative chylothorax. Conclusion    Compared with the VATS, the rate of chylothorax after RATS is higher with more dissected lymph nodes and less blood loss. The incidence of chylothorax after minimally invasive radical lung cancer resection is higher in the patients with increased dissected lymph node groups and smoking history.

18.
Article in Chinese | WPRIM | ID: wpr-928846

ABSTRACT

Currently, surgery-based comprehensive therapy plays an important role in the treatment of local advanced gastric cancer (LAGC), and standard lymph node dissection is a mainstay of gastric surgery. Radical gastrectomy with D2 lymph node dissection is widely accepted based on the international publications of randomized clinical trials, but the extent of lymph node dissection is controversial. An adequate lymph node dissection may improve prognosis and reduce complications, and D2+ lymphadenectomy may improve surgical outcomes in some selected patients. To improve the efficacy of LAGC therapies, the Gastric Cancer Association, China Anti Cancer Association took the lead and organized experts to discuss and vote, and finally formulated this expert consensus. It is hoped that this consensus can provide reference for clinicians and further improve the diagnosis and treatment level of LAGC in China.


Subject(s)
Consensus , Gastrectomy , Humans , Lymph Node Excision , Neoplasms, Second Primary/surgery , Prognosis , Stomach Neoplasms/pathology
19.
Rev. bras. ginecol. obstet ; 43(4): 297-303, Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1280048

ABSTRACT

Abstract Objective To evaluate the number of patients with early-stage breast cancer who could benefit from the omission of axillary surgery following the application of the Alliance for Clinical Trials in Oncology (ACOSOG) Z0011 trial criteria. Methods A retrospective cohort study conducted in the Hospital da Mulher da Universidade Estadual de Campinas. The study population included 384 women diagnosed with early-stage invasive breast cancer, clinically negative axilla, treated with breast-conserving surgery and sentinel lymph node biopsy, radiation therapy, chemotherapy and/or endocrine therapy, from January 2005 to December 2010. The ACOSOG Z0011 trial criteria were applied to this population and a statistical analysis was performed to make a comparison between populations. Results A total of 384 patients underwent breast-conserving surgery and sentinel lymph node biopsy. Of the total number of patients, 86 women underwent axillary lymph node dissection for metastatic sentinel lymph nodes (SNLs). One patient underwent axillary node dissection due to a suspicious SLN intraoperatively, thus, she was excluded fromthe study. Among these patients, 82/86 (95.3%) had one to two involved sentinel lymph nodes andmet the criteria for the ACOSOG Z0011 trial with the omission of axillary lymph node dissection. Among the 82 eligible women, there were only 13 cases (15.9%) of lymphovascular invasion and 62 cases (75.6%) of tumors measuring up to 2 cm in diameter (T1). Conclusion The ACOSOG Z0011 trial criteria can be applied to a select group of SLNpositive patients, reducing the costs and morbidities of breast cancer surgery.


Resumo Objetivo Avaliar o número de pacientes com câncer de mama em estágio inicial que se beneficiariam da omissão da linfadenectomia axilar segundo o protocolo Z0011 da Alliance for Clinical Trials in Oncology (ACOSOG). Métodos Estudo de coorte retrospectiva conduzido no Hospital da Mulher da Universidade Estadual de Campinas. Foram incluídas mulheres diagnosticadas com carcinoma invasivo de mama em estágio inicial, com axila clinicamente negativa, tratadas com cirurgia conservadora e biópsia do linfonodo sentinela, radioterapia, quimioterapia e/ou hormonioterapia, de janeiro de 2005 a dezembro de 2010. Os critérios do estudo da ACOSOG Z0011 foram aplicados a essas mulheres e foi realizada uma análise estatística que comparou ambas as populações dos estudos. Resultados Foram estudadas 384 mulheres submetidas a cirurgia conservadora de mama e biópsia do linfonodo sentinela. Entre elas, 86 mulheres foram submetidas a linfadenectomia axilar por metástase presente no linfonodo sentinela. Uma paciente foi submetida a linfadenectomia axilar por ter um linfonodo palpável suspeito no intraoperatório, não incluída no estudo. Entre essas 86 pacientes, 82 (95,3%) tiveram de 1 a 2 linfonodos sentinela comprometidos e seriam elegíveis para omissão da linfadenectomia axilar pelos critérios do ACOSOG Z0011. Entre as 82 pacientes elegíveis, apenas 13 (15,9%) delas apresentaram tumores com invasão angiolinfática, e 62 (75,6%) dos tumores mediram até 2 cm (T1). Conclusão Os critérios do estudo ACOZOG Z0011 podem ser aplicados a um seleto grupo de pacientes com linfonodo sentinela positivo reduzindo os custos e a morbidade cirúrgica do tratamento do câncer de mama.


Subject(s)
Humans , Female , Breast Neoplasms/surgery , Breast Neoplasms/pathology , Mastectomy, Segmental , Lymph Node Excision , Axilla/pathology , Randomized Controlled Trials as Topic , Retrospective Studies , Chemotherapy, Adjuvant , Radiotherapy, Adjuvant , Sentinel Lymph Node Biopsy , Lymph Nodes/pathology , Lymphatic Metastasis , Middle Aged , Neoplasm Staging
20.
Rev. argent. mastología ; 40(145): 65-80, mar. 2021. tab, graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1291291

ABSTRACT

El estado axilar es un factor pronóstico para los estadios tempranos de cáncer de mama. Existen factores que podrían predecir riesgo de mayor enfermedad axilar. El objetivo es determinar cuáles son los factores predictivos independientes de alta carga residual ganglionar axilar (4 o más GNC comprometidos) luego de la BGC positiva. Estudio analítico, observacional, cohorte retrospectiva de pacientes con tumores T1-2, axila clínicamente negativa, a las que se les realizó cirugía conservadora (CC) y BGC con resultado positivo (marco o micrometástasis) y se les realizó posterior linfadenectomía axilar (LA). Del total de 325 pacientes, 96 tuvieron resultado positivo para metástasis en el ganglio centinela (29,5%) y también se les realizó LA. Se dividió a la población seleccionada en dos grupos según el compromiso de los GNC: baja carga axilar 0-3 GNC positivos, y alta carga axilar 4 o más GNC positivos. Se observaron como factores que demostraron mayor riesgo para alta carga axilar ganglionar residual al grado histológico, ki-67 y la invasión extracapsular en el GC; pero solamente la invasión extracapsular en el GC demostró ser significativa en el análisis multivariado. Probablemente con un mayor número de pacientes otras variables pudieran haber resultado factores de riesgo independiente


Axillary status is a prognostic factor for early stages of breast cáncer. There are predictive factors that might indicate the risk of greater axilary disease. The aim is to determine which are the independent predictive factor sor a high residual axillary nodal burden (four or more non-sentinel lymph nodes involved) after a positive sentinel node biopsy. Retrospective cohort analytic observational study of patients with T1-2 tumors, negative axilla, who underwent breast conserving surgery and sentinel node biopsy with a positive result (macro ­ or micro-metastasis) and later underwent lymph node dissection. Out of the total 325 patients, 96 got a positive result for metástasis in the sentinel lymph node (29.5%) and also underwent lymph node dissection. The selected population was divided into two groups according to the involvement of NSLNs: low axillary burden: 0-3 NSLNs, and high axillary burden: 4 or more positive NSLNs. Among the factors found to have a higher risk of high residual axillary nodal burden were the histologic grade, Ki-67 and the extracapsular invasión of the SLN, but only the extracapsular invasión of the SLN was found to be significant in the multivariate analysis. It is likely that with a higher number of patients, other variables might have been independent risk factors


Subject(s)
Humans , Female , Sentinel Lymph Node , Axilla , Biopsy , Breast Neoplasms , Lymph Node Excision , Lymph Nodes
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