RÉSUMÉ
Objective To explore the impact of systematic retroperitoneal lymphadenectomy (SL) in patients with advanced ovarian cancer. Methods The data on 188 patients with FIGO stageⅢC epithelial ovarian cancer were retrospectively analyzed. All the patients underwent primary debulking surgery and then received platinum-based chemotherapy. The patients were divided into SL group and non-systematic lymphadenectomy (USL) group. Progression free survival (PFS) and overall survival (OS) times were analyzed. Results PFS and OS were higher in SL group than in USL group (36 versus 17 months and P = 0.022; 58 versus 52 months and P = 0.041). Univariate analysis showed that both SL and optimal debulking surgery were the independent prognostic factors , but multivariate analysis indicated that optimal debulking surgery was the only independent prognostic factor. However , for 143 patients without enlarged retroperitoneal lymph nodes , multivariate analysis showed that either SL or optimal debulking surgery were the independent prognostic factor (P = 0.040 and P = 0.014). Conclusions Optimal debulking surgery is helpful in improvement of the survival in patients with advanced ovarian cancer. For patients without enlarged retroperitoneal lymph nodes, SL still has a positive effect on the prognosis.
RÉSUMÉ
We designed this study to identify the anatomic variations of the accessory left hepatic artery and to identify the influence on the hepatic function when this vessel is sacrificed during a systematic lymphadenectomy for gastric cancer. The surgical records of 100 patients who underwent curative surgery for gastric cancer, including ligation of the left gastric artery at its origin, were reviewed. The liver function was assessed by measuring the serum glutamic oxaloacetic transaminase, the glutamic pyruvic transaminase, and the alkaline phosphatase activities preoperatively and on the seventh postoperative day. The frequency of metastasis in the lymph nodes around the left gastric artery was reviewed. In 44 of the 100 cases, an accessory left hepatic artery was encountered. The accessory left hepatic artery joined with the left hepatic artery before reaching the liver in 21 of 44 cases and ran into the left lobe of the liver without confluence in 23. The diameter of the accessory left hepatic artery was greater than that of the left hepatic artery in only 17% of the cases. Metastasis in the lymph nodes around the left gastric artery was identified in 11 cases. The observed hepatic dysfunctions 7 days after operation were mild and transient, even after sacrifice of the accessory left hepatic artery. There were no postoperative complications related to the decreased liver function in these patients. These data suggest that ligation of the left gastric artery at its origin, irrespective of the presence of an accessory left hepatic artery, is necessary to improve the oncological quality of surgery without significant complication during curative surgery for gastric cancer.