ABSTRACT
BACKGROUND: The purpose of this study was to evaluate the feasibility and reliability of ex vivo sentinel lymph node mapping in patients with colorectal cancer. METHODS: In the period January-June 2006, 44 consecutive patients underwent curative surgery for colorectal cancer. In patients with colon and rectal cancer, 0.5-2 ml of Patent Blue Dye was injected submucosally. The injection sites where then gently massaged for 5 min. RESULTS: In 96% of the patients with colon cancer and 94% of the patients with rectal cancer, at least one sentinel lymph node was found. There were no patients with a false negative sentinel node. The sensitivity was 100% with a negative predictive value of 100%. In 19% of the patients with colon cancer and 18% of the patients with rectal cancer the sentinel node was the exclusive site of lymph node metastases. After additional sectioning and staining, 7 of the 23 patients (30%) with a Dukes B colorectal cancer were upstaged. CONCLUSION: The technique of ex vivo sentinel lymph node mapping is technically feasible with high sensitivity, high negative predictive value and a high rate of upstaging. The next step is to investigate, if detection of micro-metastases is associated with decreased survival and/or increased local recurrence rates.
Subject(s)
Colorectal Neoplasms/pathology , Colorectal Neoplasms/surgery , Sentinel Lymph Node Biopsy/methods , Colectomy , Feasibility Studies , Humans , Lymphatic Metastasis , Neoplasm Staging , Predictive Value of Tests , Reproducibility of Results , Rosaniline DyesABSTRACT
BACKGROUND: Rectourethral fistula is a rare complication of radical prostatectomy. Transanal endoscopic microsurgery (TEM) is a minimally invasive technique available for its surgical correction, although currently, TEM is used more commonly for excision of adenomas and stage T(1) carcinomas of the rectum. PATIENTS AND METHODS: We report two patients with rectourethral fistulae after laparoscopic radical prostatectomy in whom TEM was used for closure. The surgical procedure included microscopic full-thickness excision of the rectal wall around the fistula with a 1-cm margin and endoscopic suturing of the defect in the urethral and rectal walls. RESULTS: In one case, the rectourethral fistula was closed using TEM. In the other patient, the procedure, performed after failure of a graciloplasty, was difficult because of extensive scar tissue, and the fistula persisted. CONCLUSIONS: The TEM procedure is a minimally invasive technique that may be considered for surgical repair of rectourethral fistulae.
Subject(s)
Anal Canal , Endoscopes , Microsurgery/methods , Rectal Fistula/surgery , Urinary Fistula/surgery , Aged , Humans , Male , Microsurgery/instrumentation , Middle Aged , Rectal Fistula/pathology , Urinary Fistula/pathologyABSTRACT
BACKGROUNDS/AIMS: This study evaluates the 3-year follow-up period and recurrence rate in patients with a negative sentinel node biopsy (SNB) without an additional axillary dissection (ALND). METHODS: Between January 2000 and March 2002, 197 patients with an invasive breast cancer and clinically negative axillary nodes underwent a sentinel node biopsy. One hundred and thirteen patients were included in our study. The follow-up consisted of clinical examination every 3 months in the first year, followed by every 6 months after the first year. A mammography was obtained annually. Attention was paid to loco-regional recurrence, including axillary recurrence, and distant metastases. RESULTS: The mean duration of follow-up was 37.5 months (range 24-54). In this period, one patient was diagnosed with an axillary recurrence and one patient developed a supraclavicular lymph node metastasis. Two patients developed a second primary breast cancer in the contralateral breast. No patients were diagnosed with distant metastasis. CONCLUSION: These 3 year follow-up results suggest that SNB is a procedure with a low clinical recurrence rate, which can replace, when strict criteria are met, ALND if the sentinel node is negative.
