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1.
Rev. colomb. cir ; 39(1): 94-99, 20240102. fig, tab
Article in Spanish | LILACS | ID: biblio-1526827

ABSTRACT

Introducción. La gastrectomía y disección ganglionar es el estándar de manejo para los pacientes con cáncer gástrico. Factores como la identificación de ganglios por el patólogo, pueden tener un impacto negativo en la estadificación y el tratamiento. El objetivo de este estudio fue comparar el recuento ganglionar de un espécimen quirúrgico después de una gastrectomía completa (grupo A) y de un espécimen con un fraccionamiento por grupos ganglionares (grupo B). Métodos. Estudio de una base de datos retrospectiva de pacientes sometidos a gastrectomía D2 en el Servicio de Cirugía gastrointestinal de la Liga Contra el Cáncer seccional Risaralda, Pereira, Colombia. Se comparó el recuento ganglionar en especímenes quirúrgicos con y sin división ganglionar por regiones anatómicas previo a su envío a patología. Resultados. De los 94 pacientes intervenidos, 65 pertenecían al grupo A y 29 pacientes al grupo B. El promedio de ganglios fue de 24,4±8,6 y 32,4±14,4 respectivamente (p=0,004). El porcentaje de pacientes con más de 15 y de 25 ganglios fue menor en el grupo A que en el grupo B (27 vs 57, p=0,432 y 19 vs 24, p=0,014). El promedio de pacientes con una relación ganglionar menor 0,2 fue mayor en el grupo B (72,4 % vs 55,4 %, p=0,119). Conclusiones. Los resultados de nuestro estudio mostraron que una división por grupos ganglionares previo a la valoración del espécimen por el servicio de patología incrementa el recuento ganglionar y permite establecer de manera certera el pronóstico de los pacientes, teniendo un impacto positivo en su estadificación, para evitar el sobretratamiento


Introduction. A gastrectomy and lymph node dissection is the standard of management for patients with gastric cancer. Factors such as the identification of nodes by the pathologist can have a negative impact on staging and treatment. The objective of this study was to compare the lymph node count of a surgical specimen after a complete gastrectomy (group A) and of a specimen with lymph node by groups (group B). Methods. Study of a retrospective database of patients undergoing D2 gastrectomy in the Risaralda section of the Liga Contra el Cancer Gastrointestinal surgical service, Pereira, Colombia. The lymph node count was compared in surgical specimens with and without lymph node division by anatomical regions, prior to sending them to pathology. Results. Of the 94 patients who underwent surgery, 65 were from group A and 29 patients were from group B. The average number of nodes was 24.4±8.6 and 32.4±14.4, respectively (p=0.004). The percentage of patients with more than 15 and 25 nodes was lower in group A than in group B (27 vs 57, p=0.432 and 19 vs 24, p=0.014). The average number of patients with a nodal ratio less than 0.2 was higher in group B (72.4% vs 55.4%, p=0.119). Conclusions. The results of our study showed that a division by lymph node groups prior to the evaluation of the specimen by the pathology service increases the lymph node count and allows the prognosis of patients to be accurately established, having a positive impact on their staging, to avoid overtreatment.


Subject(s)
Humans , Stomach Neoplasms , Lymph Node Excision , Neoplasm Staging , Gastrectomy , Lymph Nodes , Lymphatic Metastasis
2.
Oncología (Guayaquil) ; 33(2): 153-161, 14 de agosto del 2023.
Article in Spanish | LILACS | ID: biblio-1451571

ABSTRACT

Introducción: La biopsia selectiva del ganglio centinela (BSGC) en cáncer de mama es el método estándar para estadificación axilar en pacientes con axila clínicamente negativa. Estudios indican evitar linfadenectomía axilar en pacientes con BSGC negativas incluyendo aquellos que recibieron previamente quimioterapia neoadyuvante (QTN). El objetivo del presente estudio es determinar la eficacia de la BSGC en detectar ganglios centinela posterior QTN en un instituto oncológico de referencia en Ecuador. Materiales y Métodos: Estudio observacional, analítico y retrospectivo, realizado en Hospital SOLCA Guayaquil, durante el período enero 2015 a diciembre 2020. Se evaluaron 81 pacientes con cáncer de mama con axila clínicamente negativa que recibieron QTN previo a cirugía. Las variables son biopsia de ganglio centinela, quimioterapia neoadyuvante, precisión diagnóstica y estadificación axilar. Se consideró el Odds Ratio del 95%, con una P<0.05. Resultados: De 81 pacientes operados, 52 pacientes recibieron BSGC con muestreo detectándose ganglio centinela en 92.3% de los casos. El porcentaje de falsos negativos es 21.7% posterior a QTN. Los 29 pacientes restantes recibieron linfadenectomía axilar. Conclusión: La BSGC es efectiva para detectar el ganglio centinela en pacientes con cáncer de mama y axila clínicamente negativa, incluso después de la quimioterapia neoadyuvante. Sin embargo, existe un riesgo significativo de falsos negativos después de la QTN, lo que puede llevar a la necesidad de realizar una linfadenectomía axilar adicional para una evaluación más precisa de la estadificación axilar.


Introduction: Selective sentinel lymph node biopsy (SLNB) in breast cancer is the standard method for axillary staging in patients with clinically negative axilla. Studies indicate avoiding axillary lymphadenectomy in patients with negative SLNB, including those who previously received neoadjuvant chemotherapy (NQT). This study aims to determine the efficacy of SLNB in detecting sentinel lymph nodes after QTN in a reference cancer institute in Ecuador. Materials and Methods: An observational, analytical, and retrospective study was conducted at Hospital SOLCA Guayaquil from January 2015 to December 2020. Eighty-one clinically negative axillary breast cancer patients who received CTN before surgery were evaluated. The variables are sentinel node biopsy, neoadjuvant chemotherapy, diagnostic accuracy, and axillary staging. An odds ratio of 95% was considered, with P <0.05. Results: Of 81 operated patients, 52 received SLNB, with sampling detecting sentinel nodes in 92.3% of the cases. The percentage of false negatives is 21.7% after QTN. The remaining 29 patients received axillary lymphadenectomy. Conclusion: SLNB effectively detects the sentinel node in patients with clinically negative breast and axillary cancer, even after neoadjuvant chemotherapy. However, there is a significant risk of false negatives after CTN, which may lead to the need to perform additional axillary lymphadenectomy for a more accurate assessment of axillary staging.


Subject(s)
Humans , Adult , Biopsy , Sentinel Lymph Node , Lymph Node Excision , General Surgery , Breast Neoplasms , Neoadjuvant Therapy , Observational Study
3.
Chinese Journal of Surgery ; (12): 582-589, 2023.
Article in Chinese | WPRIM | ID: wpr-985812

ABSTRACT

Objectives: To evaluate the positive rate of left posterior lymph nodes of the superior mesenteric artery (14cd-LN) in patients undergoing pancreaticoduodenectomy for pancreatic head carcinoma,to analyze the impact of 14cd-LN dissection on lymph node staging and tumor TNM staging. Methods: The clinical and pathological data of 103 consecutive patients with pancreatic cancer who underwent pancreaticoduodenectomy at Pancreatic Center,the First Affiliated Hospital of Nanjing Medical University from January to December 2022 were analyzed,retrospectively. There were 69 males and 34 females,with an age(M (IQR))of 63.0 (14.0) years (range:48.0 to 86.0 years). The χ2 test and Fisher's exact probability method was used for comparison of the count data between the groups,respectively. The rank sum test was used for comparison of the measurement data between groups. Univariate and multivariate Logistic regression analyzes were used for the analysis of risk factors. Results: All 103 patients underwent pancreaticoduodenectomy successfully using the left-sided uncinate process and the artery first approach. Pathological examination showed pancreatic ductal adenocarcinoma in all cases. The location of the tumors was the pancreatic head in 40 cases,pancreatic head-uncinate in 45 cases,and pancreatic head-neck in 18 cases. Of the 103 patients,38 cases had moderately differentiated tumor and 65 cases had poorly differentiated tumor. The diameter of the lesions was 3.2 (0.8) cm (range:1.7 to 6.5 cm),the number of lymph nodes harvested was 25 (10) (range:11 to 53),and the number of positive lymph nodes was 1 (3) (range:0 to 40). The lymph node stage was stage N0 in 35 cases (34.0%),stage N1 in 43 cases (41.7%),and stage N2 in 25 cases (24.3%). TNM staging was stage ⅠA in 5 cases (4.9%),stage ⅠB in 19 cases (18.4%),stage ⅡA in 2 cases (1.9%),stage ⅡB in 38 cases (36.9%),stage Ⅲ in 38 cases (36.9%),and stage Ⅳ in 1 case (1.0%). In 103 patients with pancreatic head cancer,the overall positivity rate for 14cd-LN was 31.1% (32/103),and the positive rates for 14c-LN and 14d-LN were 21.4% (22/103) and 18.4% (19/103),respectively. 14cd-LN dissection increased the number of lymph nodes (P<0.01) and positive lymph nodes (P<0.01). As a result of the 14cd-LN dissection,the lymph node stage was changed in 6 patients,including 5 patients changed from N0 to N1 and 1 patient changed from N1 to N2. Similarly,the TNM stage was changed in 5 patients,including 2 patients changed from stage ⅠB to ⅡB,2 patients changed from stage ⅡA to ⅡB,and 1 patient changed from stage ⅡB to Ⅲ. Tumors located in the pancreatic head-uncinate (OR=3.43,95%CI:1.08 to 10.93,P=0.037) and the positivity of 7,8,9,12 LN (OR=5.45,95%CI:1.45 to 20.44,P=0.012) were independent risk factors for 14c-LN metastasis; while tumors with diameter >3 cm (OR=3.93,95%CI:1.08 to 14.33,P=0.038) and the positivity of 7,8,9,12 LN (OR=11.09,95%CI:2.69 to 45.80,P=0.001) were independent risk factors for 14d-LN metastasis. Conclusion: Due to its high positive rate in pancreatic head cancer,dissection of 14cd-LN during pancreaticoduodenectomy should be recommended,which can increase the number of lymph nodes harvested,provide a more accurate lymph node staging and TNM staging.


Subject(s)
Male , Female , Humans , Pancreaticoduodenectomy/methods , Retrospective Studies , Prognosis , Lymph Node Excision/methods , Lymph Nodes/pathology , Pancreatic Neoplasms/pathology , Neoplasm Staging
4.
Chinese Journal of Obstetrics and Gynecology ; (12): 359-367, 2023.
Article in Chinese | WPRIM | ID: wpr-985659

ABSTRACT

Objective: To analyze the treatment and prognosis of patients with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage Ⅲc cervical squamous cell carcinoma. Methods: A total of 488 patients at Zhejiang Cancer Hospital between May, 2013 to May, 2015 were enrolled. The clinical characteristics and prognosis were compared according to the treatment mode (surgery combined with postoperative chemoradiotherapy vs radical concurrent chemoradiotherapy). The median follow-up time was (96±12) months ( range time from 84 to 108 months). Results: (1) The data were divided into surgery combined with chemoradiotherapy group (surgery group) and concurrent chemoradiotherapy group (radiotherapy group), including 324 cases in the surgery group and 164 cases in the radiotherapy group. There were significant differences in Eastern Cooperation Oncology Group (ECOG) score, FIGO 2018 stage, large tumors (≥4 cm), total treatment time and total treatment cost between the two groups (all P<0.01). (2) Prognosis: ① for stage Ⅲc1 patients, there were 299 patients in the surgery group with 250 patients survived (83.6%). In the radiotherapy group, 74 patients survived (52.9%). The difference of survival rates between the two groups was statistically significant (P<0.001). For stage Ⅲc2 patients, there were 25 patients in surgery group with 12 patients survived (48.0%). In the radiotherapy group, there were 24 cases, 8 cases survived, the survival rate was 33.3%. There was no significant difference between the two groups (P=0.296). ② For patients with large tumors (≥4 cm) in the surgery group, there were 138 patients in the Ⅲc1 group with 112 patients survived (81.2%); in the radiotherapy group, there were 108 cases with 56 cases survived (51.9%). The difference between the two groups was statistically significant (P<0.001). Large tumors accounted for 46.2% (138/299) vs 77.1% (108/140) in the surgery group and radiotherapy group. The difference between the two groups was statistically significant (P<0.001). Further stratified analysis, a total of 46 patients with large tumors of FIGO 2009 stage Ⅱb in the radiotherapy group were extracted, and the survival rate was 67.4%, there was no significant difference compared with the surgery group (81.2%; P=0.052). ③ Of 126 patients with common iliac lymph node, 83 patients survived, with a survival rate of 65.9% (83/126). In the surgery group, 48 patients survived and 17 died, with a survival rate of 73.8%. In the radiotherapy group, 35 patients survived and 26 died, with a survival rate of 57.4%. There were no significant difference between the two groups (P=0.051). (3) Side effects: the incidence of lymphocysts and intestinal obstruction in the surgery group were higher than those in the radiotherapy group, and the incidence of ureteral obstruction and acute and chronic radiation enteritis were lower than those in the radiotherapy group, and there were statistically significant differences (all P<0.01). Conclusions: For stage Ⅲc1 patients who meet the conditions for surgery, surgery combined with postoperative adjuvant chemoradiotherapy and radical chemoradiotherapy are acceptable treatment methods regardless of pelvic lymph node metastasis (excluding common iliac lymph node metastasis), even if the maximum diameter of the tumor is ≥4 cm. For patients with common iliac lymph node metastasis and stage Ⅲc2, there is no significant difference in the survival rate between the two treatment methods. Based on the duration of treatment and economic considerations, concurrent chemoradiotherapy is recommended for the patients.


Subject(s)
Female , Humans , Uterine Cervical Neoplasms/pathology , Neoplasm Staging , Lymphatic Metastasis , Lymph Node Excision , Retrospective Studies , Prognosis , Chemoradiotherapy/methods , Carcinoma, Squamous Cell/pathology
5.
Chinese Journal of Gastrointestinal Surgery ; (12): 707-712, 2023.
Article in Chinese | WPRIM | ID: wpr-986841

ABSTRACT

In the past decade, the concept of membrane anatomy has been gradually applied in gastric cancer surgery. Based on this theory, D2 lymphadenectomy plus complete mesogastric excision (D2+CME) has been proposed, which has been demonstrated to significantly reduce intraoperative bleeding and intraperitoneal free cancer cells during surgery, decrease surgical complications, and improve survival. These results indicate that membrane anatomy is feasible and efficacious in gastric cancer surgery. In this review, we will describe the important contents of membrane anatomy, including "Metastasis V"(2013, 2015), proximal segmentation of dorsal mesogastrium (2015), D2+CME procedure (2016), "cancer leak"(2018), and surgical outcomes of D2+CME (2022).


Subject(s)
Humans , Stomach Neoplasms/pathology , Gastrectomy/methods , Laparoscopy/methods , Lymph Node Excision/methods , Mesentery/surgery
6.
Chinese Journal of Gastrointestinal Surgery ; (12): 701-706, 2023.
Article in Chinese | WPRIM | ID: wpr-986840

ABSTRACT

Although it has become a consensus in the field of colorectal surgery to perform radical tumor treatment and functional protection under the minimally invasive concept, there exist many controversies during clinical practice, including the concept of embryonic development of abdominal organs and membrane anatomy, the principle of membrane anatomy related to right hemicolectomy, D3 resection, and identification of the inner boundary. In this paper, we analyzed recently reported literature with high-level evidence and clinical data from the author's hospital to recognize and review the membrane anatomy-based laparoscopic assisted right hemicolectomy for right colon cancer, emphasizing the importance of priority of surgical dissection planes, vascular orientation, and full understanding of the fascial space, and proposing that the surgical planes should be dissected in the parietal-prerenal fascial space, and the incision should be 1 cm from the descending and horizontal part of the duodenum. The surgery should be performed according to a standard procedure with strict quality control. To identify the resection range of D3 dissection, it is necessary to establish a clinical, imaging, and pathological evaluation model for multiple factors or to apply indocyanine green and nano-carbon lymphatic tracer intraoperatively to guide precise lymph node dissection. We expect more high-level evidence of evidence-based medicine to prove the inner boundary of laparoscopic assisted radical right colectomy and a more rigorous consensus to be established.


Subject(s)
Humans , Laparoscopy/methods , Colonic Neoplasms/pathology , Lymph Node Excision/methods , Colectomy/methods , Dissection
7.
Chinese Journal of Gastrointestinal Surgery ; (12): 644-649, 2023.
Article in Chinese | WPRIM | ID: wpr-986833

ABSTRACT

Radical resection of gastrointestinal tumors based on the membrane anatomy theory has significantly reduced the postoperative recurrence rate and improved the surgical efficacy. However, the theory of membrane anatomy has not been widely adopted in radical surgery for esophageal cancer. Our study found that the esophagus also has a membranous anatomical structure. As a foregut organ, the esophagus also has a mesenteric structure, and there is also a fifth metastasis pathway within the esophageal mesentery for esophageal cancers. The leak and metastasis of cancer caused by destruction of the mesenteric integrity may be the fundamental reason for the high postoperative recurrence rate. Using the nano carbon and indocyanine green fluorescence tracing technique, we demonstrated the lymphatic drainage of the upper esophageal segment to the left gastric artery mesenteric lymph nodes. Therefore, in the radical resection of esophageal cancer, we used the membrane anatomy theory for guidance to completely remove the esophageal cancer, esophageal mesentery, left gastric artery and its mesentery, as well as all structures within the mesentery, preventing the spread of cancer cells through the blood vessels, lymphatic system, and mesentery, and improving the efficacy and prognosis. This article elaborates on the theoretical basis of the anatomical structure of the esophageal membrane, embryonic development, imaging, autopsy, and endoscopic observation of the structure, as well as the application effect of the esophageal membrane anatomical theory in esophageal cancer radical surgery. It elucidates the anatomical structure of the esophageal membrane and the lymphatic drainage characteristics of esophageal cancer, reveals the law of lymphatic metastasis in esophageal cancer, optimizes lymphatic dissection strategies, and improves the efficacy of esophageal cancer radical surgery.


Subject(s)
Humans , Lymph Node Excision/methods , Esophageal Neoplasms/surgery , Lymph Nodes , Endoscopy , Dissection
8.
Chinese Journal of Gastrointestinal Surgery ; (12): 639-643, 2023.
Article in Chinese | WPRIM | ID: wpr-986832

ABSTRACT

Complete mesocolic excision (CME) and D3 resection of right colon cancer have been widely implemented, but the definition and identification of the completeness of the mesentery have not been fully agreed, especially the dorsal and medial borders. In this paper, we proposed the dorsal fascia of the colonic mesentery as the dorsal border of the mesocolon and the line connecting the roots of the ileocolic artery and the middle colic artery (ICA-MCA line) as the medial border of the CME by systematically studying the relationship between the mesentery and the mesenteric bed from the theory of membrane anatomy, combined with surgical experience and in-depth review of ontogenetic anatomy. We also proposed the visible "superior mesenteric vein notch" and "middle colic artery triangle" on surgical specimens as identifiers of mesocolic completeness.


Subject(s)
Humans , Mesocolon/surgery , Lymph Node Excision , Colectomy , Laparoscopy , Colonic Neoplasms/surgery
9.
Chinese Journal of Gastrointestinal Surgery ; (12): 633-638, 2023.
Article in Chinese | WPRIM | ID: wpr-986831

ABSTRACT

There is a consensus that selectively perform splenic lymph node dissection is necessary for high-risk patients with proximal gastric cancer to achieve radical treatment. However, there are still some outstanding issues that need to be solved during the practice of splenic lymph node dissection. These include poorly defined boundaries, technical difficulties, and blurred boundaries in No. 10 and No. 11 lymph nodes, etc. Membrane anatomy has achieved successful applications in the field of gastric and colorectal surgery in recent years. The study of membrane anatomy in the splenic hilum region is controversial due to the special location of the splenic hilum, which involves multiple organs and affiliated mesentery undergoing complex rotation, folding, and fusion during embryonic development. In this manuscript, we summarize the following points based on existing research and personal experience regarding membrane anatomy. 1. There is a membrane anatomical structure that can be used for lymph node dissection in the splenic hilum region. 2. The membrane structure in the splenic hilum region can be divided into two layers: the superficial layer is composed of the dorsal mesogastrium, and the deep layer is composed of Gerota fascia, the tail of the pancreas, and the mesentery of the transverse colon (from head to tail). 3. There is a loose space between the two layers that can be used for separation during surgery. The resection of the dorsal mesogastrium belongs to D2 dissection. The No. 10 lymph node in the deeper layer belongs to the duodenal mesentery, and the resection of the No.10 lymph node exceeds D2 dissection. The complete excision of the gastric dorsal mesentery is consistent with the D2+CME surgical mode proposed by Gong Jianping's group.


Subject(s)
Humans , Stomach Neoplasms/pathology , Laparoscopy , Gastrectomy , Lymph Nodes/pathology , Lymph Node Excision
10.
Chinese Journal of Gastrointestinal Surgery ; (12): 619-624, 2023.
Article in Chinese | WPRIM | ID: wpr-986829

ABSTRACT

The successful report of total mesorectal excision (TME)/complete mesocolic excision (CME) has encouraged people to apply this concept beyond colorectal surgery. However, the negative results of the JCOG1001 trial denied the effect of complete resection of the "mesogastrium" including the greater omentum on the oncological survival of gastric cancer patients. People even believe that the mesentery is unique in the intestine, because they have a vague understanding of the structure of the mesentery. The discovery of proximal segment of the dorsal mesogastrium (PSDM) proved that the greater omentum is not the mesogastrium, and further revised the structure (definition) of the mesentery and revealed its container characteristics, i.e. the mesentery is an envelope-like structure, which is formed by the primary fascia (and serosa) that enclose the tissue/organ/system and its feeding structures, leading to and suspended on the posterior wall of the body. Breakdown of this structure leads to the simultaneous reduction of surgical and oncological effects of surgery. People quickly realized the universality of this structure and causality which cannot be matched by the existing theories of organ anatomy and vascular anatomy, so a new theory and surgical map- membrane anatomy began to form, which led to radical surgery upgraded from histological en bloc resection to anatomic en bloc resection.


Subject(s)
Humans , Fascia/anatomy & histology , Laparoscopy , Lymph Node Excision/methods , Mesentery/surgery , Mesocolon/surgery , Omentum , Serous Membrane , Clinical Trials as Topic
11.
Chinese Journal of Gastrointestinal Surgery ; (12): 339-345, 2023.
Article in Chinese | WPRIM | ID: wpr-986796

ABSTRACT

Objective: We aimed to explore the feasibility of a single-port thoracoscopy- assisted five-step laparoscopic procedure via transabdominal diaphragmatic(TD) approach(abbreviated as five-step maneuver) for No.111 lymphadenectomy in patients with Siewert type II esophageal gastric junction adenocarcinoma (AEG). Methods: This was a descriptive case series study. The inclusion criteria were as follows: (1) age 18-80 years; (2) diagnosis of Siewert type II AEG; (3) clinical tumor stage cT2-4aNanyM0; (4) meeting indications of the transthoracic single-port assisted laparoscopic five-step procedure incorporating lower mediastinal lymph node dissection via a TD approach; (5) Eastern Cooperative Oncology Group performance status (ECOG PS) 0-1; and (6) American Society of Anesthesiologists classification I, II, or III. The exclusion criteria included previous esophageal or gastric surgery, other cancers within the previous 5 years, pregnancy or lactation, and serious medical conditions. We retrospectively collected and analyzed the clinical data of 17 patients (age [mean ± SD], [63.6±11.9] years; and 12 men) who met the inclusion criteria in the Guangdong Provincial Hospital of Chinese Medicine from January 2022 to September 2022. No.111 lymphadenectomy was performed using five-step maneuver as follows: superior to the diaphragm, starting caudad to the pericardium, along the direction of the cardio-phrenic angle and ending at the upper part of the cardio-phrenic angle, right to the right pleura and left to the fibrous pericardium , completely exposing the cardio-phrenic angle. The primary outcome includes the numbers of harvested and of positive No.111 lymph nodes. Results: Seventeen patients (3 proximal gastrectomy and 14 total gastrectomy) had undergone the five-step maneuver including lower mediastinal lymphadenectomy without conversion to laparotomy or thoracotomy and all had achieved R0 resection with no perioperative deaths. The total operative time was (268.2±32.9) minutes, and the lower mediastinal lymph node dissection time was (34.0±6.0) minutes. The median estimated blood loss was 50 (20-350) ml. A median of 7 (2-17) mediastinal lymph nodes and 2(0-6) No. 111 lymph nodes were harvested. No. 111 lymph node metastasis was identified in 1 patient. The time to first flatus occurred 3 (2-4) days postoperatively and thoracic drainage was used for 7 (4-15) days. The median postoperative hospital stay was 9 (6-16) days. One patient had a chylous fistula that resolved with conservative treatment. No serious complications occurred in any patient. Conclusion: The single-port thoracoscopy-assisted five-step laparoscopic procedure via a TD approach can facilitate No. 111 lymphadenectomy with few complications.


Subject(s)
Male , Female , Humans , Adolescent , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Diaphragm/surgery , Retrospective Studies , Feasibility Studies , Esophagogastric Junction/surgery , Lymph Node Excision/methods , Stomach Neoplasms/pathology , Laparoscopy/methods , Gastrectomy/methods , Esophageal Neoplasms/pathology , Adenocarcinoma/pathology , Thoracoscopy
12.
Chinese Journal of Gastrointestinal Surgery ; (12): 325-329, 2023.
Article in Chinese | WPRIM | ID: wpr-986793

ABSTRACT

Due to the anatomical specificity of esophagus, esophagectomy can be carried out using different approaches, such as left transthoracic, right transthoracic and transhiatal approaches. Each surgical approach is associated with a different prognosis due to the complex anatomy. The left transthoracic approach is no longer the primary choice due to its limitations in providing adequate exposure, lymph node dissection, and resection. The right transthoracic approach is capable of achieving a larger number of dissected lymph nodes and is currently considered the preferred procedure for radical resection. Although the transhiatal approach is less invasive, it could be challenging to perform in a limited operating space and has not been widely adopted in clinical practice. Minimally invasive esophagectomy offers a wider range of surgical options for treating esophageal cancer. This paper reviews different approaches to esophagectomy.


Subject(s)
Humans , Prognosis , Lymph Node Excision/methods , Lymph Nodes/pathology , Esophageal Neoplasms/pathology , Esophagectomy/methods
13.
Chinese Journal of Gastrointestinal Surgery ; (12): 319-324, 2023.
Article in Chinese | WPRIM | ID: wpr-986792

ABSTRACT

Esophageal cancer is a common malignant tumor in China. For resectable ones, surgery is still the primary treatment. At present, the extent of lymph node dissection remains controversial. Extended lymphadenectomy makes metastatic lymph nodes more likely to be resected, which contributed to pathological staging and postoperative treatment. However,it may also increase the risk of postoperative complications and affect prognosis. Therefore, it is controversial how to balance the optimal extent/number of dissected lymph nodes for radical resection with the lower risk of severe complications. In addition, whether the lymph node dissection strategy should be modified after neoadjuvant therapy needs to be investigated, especially for patients who have a complete response to neoadjuvant therapy. Herein, we summarize the clinical experience on the extent of lymph node dissection in China and worldwide, aiming to provide guidence for the extent of lymph node dissection in esophageal cancer.


Subject(s)
Humans , Lymphatic Metastasis/pathology , Lymph Node Excision , Lymph Nodes/pathology , Prognosis , Esophageal Neoplasms/pathology , Neoplasm Staging , Esophagectomy
14.
Acta Academiae Medicinae Sinicae ; (6): 464-470, 2023.
Article in Chinese | WPRIM | ID: wpr-981292

ABSTRACT

Bladder cancer is a common malignant tumor of the urinary system.The prognosis of patients with positive lymph nodes is worse than that of patients with negative lymph nodes.An accurate assessment of preoperative lymph node statushelps to make treatmentdecisions,such as the extent of pelvic lymphadenectomy and the use of neoadjuvant chemotherapy.Imaging examination and pathological examination are the primary methods used to assess the lymph node status of bladder cancer patients before surgery.However,these methods have low sensitivity and may lead to inaccuate staging of patients.We reviewed the research progress and made an outlook on the application of clinical diagnosis,imaging techniques,radiomics,and genomics in the preoperative evaluation of lymph node metastasis in bladder cancer patients at different stages.


Subject(s)
Humans , Lymphatic Metastasis , Neoplasm Staging , Cystectomy/methods , Urinary Bladder Neoplasms/pathology , Lymph Node Excision/methods , Lymph Nodes/pathology
15.
Journal of Central South University(Medical Sciences) ; (12): 716-724, 2023.
Article in English | WPRIM | ID: wpr-982341

ABSTRACT

OBJECTIVES@#Da Vinci robot technology is widely used in clinic,with minimally invasive surgery development. This study aims to explore the possible influence of advanced surgical robotics on the surgery learning curve by comparing the initial clinical learning curves of 2 different surgical techniques: robotic-assisted gastrectomy (RAG) and laparoscopic-assisted gastrectomy (LAG).@*METHODS@#From September 2017 to December 2020, a chief surgeon completed a total of 108 cases of radical gastric cancer from the initial stage, including 27 cases of RAG of the Da Vinci Si robotic system (RAG group) and 81 cases of LAG (LAG group). The lymph node of gastric cancer implemented by the Japanese treatment guidelines of gastric cancer. The surgical results, postoperative complications, oncology results and learning curve were analyzed.@*RESULTS@#There was no significant difference in general data, tumor size, pathological grade and clinical stage between the 2 groups (P>0.05). The incidence of serious complications in the RAG group was lower than the LAG group (P=0.003). The intraoperative blood loss in the RAG group was lower than that in the LAG group (P=0.046). The number of lymph nodes cleaned in the RAG group was more (P=0.003), among which there was obvious advantage in lymph node cleaning in the No.9 group (P=0.038) and 11p group (P=0.015). The operation time of the RAG group was significantly longer than the LAG group (P=0.015). The analysis of learning curve found that the cumulative sum analysis (CUSUM) value of the RAG group decreased from the 10th case, while the CUSUM of the LAG group decreased from the 28th case. The learning curve of the RAG group had fewer closing cases than that of the LAG group. The unique design of the surgical robot might help to improve the surgical efficiency and shorten the surgical learning curve.@*CONCLUSIONS@#Advanced robotics helps experienced surgeons quickly learn to master RAG skills. With the help of robotics, RAG are superior to LAG in No.9 and 11p lymph node dissection and surgical trauma reduction. RAG can clear more lymph nodes than LAG, and has better perioperative effect.


Subject(s)
Humans , Robotics , Robotic Surgical Procedures/methods , Learning Curve , Stomach Neoplasms/pathology , Retrospective Studies , Laparoscopy/methods , Lymph Node Excision/methods , Gastrectomy/methods , Treatment Outcome
16.
ABCD (São Paulo, Online) ; 36: e1772, 2023. graf
Article in English | LILACS | ID: biblio-1519803

ABSTRACT

ABSTRACT BACKGROUND: Para-aortic lymph nodes involvement in pancreatic head cancer has been described as an independent adverse prognostic factor. To avoid futile pancreatic resection, we systematically perform para-aortic lymphadenectomy as a first step. AIMS: To describe our technique for para-aortic lymphadenectomy. METHODS: A 77-year-old female patient, with jaundice and resectable pancreatic head adenocarcinoma, underwent pancreaticoduodenectomy associated with infracolic lymphadenectomy. RESULTS: The infracolic anterior technique has two main advantages. It is faster and prevents the formation of postoperative adhesions, which can make subsequent surgical interventions more difficult. CONCLUSIONS: We recommend systematic para-aortic lymphadenectomy as the first step of pancreaticoduodenectomy for pancreatic head adenocarcinoma by this approach.


RESUMO RACIONAL: O envolvimento dos gânglios linfáticos para-aórticos no câncer da cabeça do pâncreas tem sido descrito como um fator prognóstico adverso independente. Para evitar a ressecção pancreática inútil, realizamos sistematicamente linfadenectomia para-aórtica. OBJETIVOS: Descrever a técnica de linfadenectomia para-aórtica. MÉTODOS: Paciente do sexo feminino, 77 anos, com quadro de icterícia e adenocarcinoma da cabeça do pâncreas ressecável, submetida à duodenopancreatectomia associada à linfadenectomia infracólica. RESULTADOS: Esta técnica anterior infracólica tem duas vantagens principais: é mais rápida e evita a formação de aderências pós-operatórias, o que pode dificultar as intervenções cirúrgicas subsequentes. CONCLUSÕES: Recomendamos a linfadenectomia para-aórtica sistemática como o primeiro passo da duodenopancreatectomia para o adenocarcinoma da cabeça do pâncreas por esta abordagem.


Subject(s)
Humans , Female , Aged , Pancreatic Neoplasms/surgery , Adenocarcinoma/surgery , Pancreaticoduodenectomy/methods , Lymph Node Excision/methods , Pancreatic Neoplasms/pathology , Magnetic Resonance Imaging , Adenocarcinoma/pathology , Tomography, X-Ray Computed
17.
São Paulo; s.n; 2023. 88 p. ilus, tab.
Thesis in Portuguese | LILACS, Inca | ID: biblio-1435260

ABSTRACT

Objetivo: Avaliar a incidência das complicações pós-operatórias do estadiamento cirúrgico e qualidade de vida relacionada ao protocolo do linfonodo sentinela associado ou não à linfadenectomia sistemática no tratamento do câncer do endométrio. Métodos: Foi conduzida uma coorte prospectiva entre dezembro de 2017 e abril de 2022, incluindo mulheres com carcinoma de endométrio em estágio inicial presumido (doença restrita ao útero) e com estadiamento linfonodal, agrupadas em: Grupo LNS (somente pesquisa do linfonodo sentinela) e Grupo LNS+LND (linfonodo sentinela com adição de linfadenectomia sistemática). Foram incluídas pacientes com baixo e alto risco para metástase linfonodal. As pacientes de alto risco fazem parte do estudo ALICE (NCT03366051), um estudo prospectivo randomizado de não inferioridade. As pacientes foram avaliadas no pré-operatório, 1 mês, 6 e 12 meses, com aplicação de questionário de qualidade de vida (QQV) pelo EORTC QLQ-C30 e Cx24, avaliação clínica e perimetria para avaliar linfedema. Resultados: Foram incluídas 152 mulheres, sendo 113 (74,3%) no grupo LNS e 39 (25,7%) no grupo LNS+LND. Complicações cirúrgicas intraoperatórias ocorreram em 2 (1,3%) casos todas pertencentes ao grupo LNS+LND. Complicações cirúrgicas até 30 dias foram encontradas em 29 (19,1%) casos. As pacientes submetidas a LNS+LND apresentaram taxas gerais de complicações cirúrgicas mais altas em comparação com aquelas submetidas apenas a LNS (33,3% vs. 14,2%; p=0,011). O grupo LNS+LND apresentou maior tempo de cirurgia (p=0,001) e necessidade de UTI (p=0,001). A incidência de linfocele foi encontrada em 8 casos, apenas no grupo LNS+LND (0 vs. 20,5%; p<0,001). Para o linfedema de membros inferiores, não foi encontrada diferença entre os grupos pela avaliação perimétrica do grupo LNS comparado ao LNS+LND (23,2% vs. 13,3%; p= 0,25). O mesmo ocorreu para a avaliação clínica do linfedema, encontrado em 21,2% do grupo LNS e 33,3% do grupo LNS+LND (p=0,14). Entretanto, na avaliação de presença de linfedema pelo score de sintomas do EORTC, houve maior relato de linfedema no grupo LNS+LND (score 23,52) comparado ao grupo LNS (score 12,45) na avaliação de 12 meses (p=0,02). Além disso, encontramos associação entre avaliação clínica e linfedema relatado pelo paciente. O score médio de linfedema foi maior quando este foi detectado por exame clínico em 6 meses (30,10 vs. 7,8; p<0,001) e 12 meses (36,4 vs. 6,0; p<0,001), no entanto sem associação entre perimetria e avaliações clínicas (p=0,76). Em relação à avaliação global de qualidade de vida, não houve diferença entre os grupos aos 12 meses (p=0,21). Conclusões: Houve maior taxa geral de complicações para o grupo submetido a linfadenectomia sistemática, assim como maiores taxas de linfocele e linfedema pelo score de sintomas. Nenhuma diferença foi encontrada em relação à qualidade de vida entre os grupos LNS e LNS+LND


Objectives: To evaluate the incidence of postoperative complications of surgical lymph node staging procedures and quality of life related to the sentinel lymph node protocol associated or not with systemic lymphadenectomy in the treatment of endometrial cancer. Methods: A prospective cohort was conducted between December 2017 and April 2022. Women with presumed early-stage endometrial carcinoma (disease restricted to the uterus) and with lymph node staging were included, grouped as follows: SLN group (sentinel lymph node only) and SLN+LND Group (sentinel lymph node with addition of systematic lymphadenectomy). Patients with low and high risk for lymph node metastasis were included, and high-risk patients were part of the ALICE study (NCT03366051), a prospective randomized non-inferiority study. The patients were assessed preoperatively, 1 month, 6 and 12 months with the application of a quality-of-life questionnaire (QQL) using the EORTC QLQ-C30 and Cx24, clinical evaluation and perimetry to assess lymphedema. Results: 152 women were included, 113 (74.3%) women in the SLN group and 39 (25.7%) in the SLN+LND group. Intraoperative surgical complications occurred in 2 (1.3%) cases, all of them in the SLN+LND group. Surgical complications within 30 days were found in 29 (19.1%) cases. Patients undergoing SLN+LND had higher overall rates of surgical complications compared to women undergoing SLN alone (33.3% vs. 14.2%; p=0.011). The SLN+LND group had longer surgery time (p=0.001) and need for ICU (p=0.001). The incidence of lymphocele was found in 8 cases and only in the SLN+LND group (0 vs. 20.5%; p<0.001). For lower limbs lymphedema, no difference was found between the groups by the perimetric evaluation of the SLN group compared to the SLN+LND (23.2% vs. 13.3%; p=0.25). The same occurred for the clinical evaluation of lymphedema, being found in 21.2% for the SLN group and 33.3% for the SLN+LND group (p=0.14). However, when evaluating the presence of lymphedema using the EORTC symptom score, there was a higher number of lymphedema reports in the SLN+LND group (score 23.52) compared to the SLN group (score 12.45) at the 12-month evaluation (p=0.02). In addition, we found an association between clinical evaluation and lymphedema reported by the patient. The lymphedema score had a higher mean score when lymphedema was detected by clinical examination at 6 months (30.10 vs. 7.8; p<0.001) and 12 months (36.4 vs. 6.0; p<0.001), however with no association between perimetry and clinical evaluations (p=0.76). Regarding the overall assessment of quality of life, there was no difference between the groups at 12 months (p=0.21). Conclusions: There was a higher overall rate of complications for the group undergoing systematic lymphadenectomy, as well as higher rates of lymphocele and lymphedema according to the symptom score. No difference was found regarding quality of life between the LNS and LNS+LND groups


Subject(s)
Humans , Female , Endometrial Neoplasms/surgery , Endometrial Neoplasms/complications , Sentinel Lymph Node , Quality of Life , Lymph Node Excision
18.
Chinese Journal of Gastrointestinal Surgery ; (12): 202-206, 2023.
Article in Chinese | WPRIM | ID: wpr-971252

ABSTRACT

With the gradual increase in the diagnosis rate of early gastric cancer, clinicians must consider prevention of gastric anatomical structure and physiological function while ensuring the radical treatment of the tumor. Pylorus-preserving gastrectomy is a function- preserving operation that preserves the pylorus, inferior pyloric vessel, and the vagus nerve in patients with early middle gastric cancer. One of the major controversies at present is the thoroughness of limited lymph node dissection for pyloric-preserving gastrectomy. Various studies have reported that the lymph node metastasis rate of early middle gastric cancer was low, especially in the suprapyloric region, inferior pylorus and the upper pancreatic region. Partial lymph node dissection is required for vascular and neurological protection, which is also safe and feasible in studies reported by major centers. Many clinical studies have been carried out in Japan and Korea, and postoperative follow-up has gradually increased evidence, providing the basis for the safety of lymph node dissection. In large case studies comparing pylorus- preserving gastrectomy with traditional distal gastrectomy, the incidence of postoperative morbidity, such as dumping syndrome, bile reflux esophagitis, weight loss, and malnutrition is low. Sentinel lymph node navigation technology is gradually applied to the diagnosis and treatment of early gastric cancer, and its clinical application value still needs further research.


Subject(s)
Humans , Pylorus/pathology , Stomach Neoplasms/pathology , Gastrectomy , Gastroenterostomy , Lymph Node Excision
19.
Chinese Journal of Gastrointestinal Surgery ; (12): 132-137, 2023.
Article in Chinese | WPRIM | ID: wpr-971242

ABSTRACT

Hilar splenic lymph node metastasis is one of the risk factors for poor prognosis in patients with proximal gastric cancer. Laparoscopic spleen-preserving splenic hilar lymph node dissection (LSPSHLD) can effectively improve the survival benefits of patients at high risk of splenic hilar lymph node metastasis. However, LSPSHLD is still a challenging surgical difficulty in radical resection of proximal gastric cancer. Moreover, improper operation can easily lead to splenic vascular injury, spleen injury and pancreatic injury and other related complications, due to the deep anatomical location of the splenic hilar region and the intricate blood vessels.Therefore, in the prevention and treatment of LSPSHLD-related complications, we should first focus on prevention, clarify the indication of surgery, and select the benefit group of LSPSHLD individually, so as to avoid the risk caused by over-dissection. Meanwhile, during the perioperative period of LSPSHLD, it is necessary to improve the cognition of related risk factors, conduct standardized and accurate operations in good surgical field exposure and correct anatomical level to avoid surrounding tissues and organs injury, and master the surgical skills and effective measures to deal with related complications, so as to improve the surgical safety of LSPSHLD.


Subject(s)
Humans , Spleen/surgery , Lymphatic Metastasis/pathology , Stomach Neoplasms/pathology , Gastrectomy/adverse effects , Lymph Node Excision/adverse effects , Lymph Nodes/pathology , Laparoscopy/adverse effects , Retrospective Studies
20.
Chinese Journal of Gastrointestinal Surgery ; (12): 121-125, 2023.
Article in Chinese | WPRIM | ID: wpr-971240

ABSTRACT

Gastric cancer is one of the most common gastrointestinal malignancies in China. D2 radical gastrectomy is the main treatment for advanced gastric cancer patients. With the advancement of laparoscopic technology, laparoscopic radical gastrectomy has been gradually developed in the world, and even popularized in China. There have been a lot of literature reports on the indications, the scope of lymph node dissection and the improvement of techniques of laparoscopic radical gastrectomy for gastric cancer. Relevant guidelines or consensus for radical gastrectomy. The prevention and treatment of complications of gastrointestinal reconstruction for laparoscopic radical gastric cancer surgery is a major concern for gastrointestinal surgeons. Once complications occur in digestive tract reconstruction, it would increase the hospitalization cost, prolong the hospitalization stay of patients, delay follow-up chemotherapy, and even lead to postoperative death or other serious consequences. Therefore, it is of positive and far-reaching clinical significance to pay attention to the techniques of gastrointestinal reconstruction after laparoscopic radical gastric cancer surgery, to reduce the occurrence of gastrointestinal reconstruction complications, and to detect and reasonably manage related complications in a timely manner. The Chinese expert consensus on prevention and treatment of complications related to digestive tract reconstruction after laparoscopic radical gastrectomy for gastric cancer (2022 edition) has significance value for reducing the occurrence of gastrointestinal reconstruction complications. This manuscript mainly serves as the interpretation and supplement of this Consensus.


Subject(s)
Humans , Consensus , Gastrectomy/methods , Laparoscopy/adverse effects , Lymph Node Excision , Retrospective Studies , Stomach Neoplasms/pathology , China
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