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Node Dissection (node + dissection)
Kinds of Node Dissection Selected AbstractsPrecipitating Factors for Lymphedema Following Surgical Treatment of Breast Cancer: Implications for Patients Undergoing Axillary Lymph Node DissectionTHE BREAST JOURNAL, Issue 2 2009Murat Dayangac MD No abstract is available for this article. [source] Safety of Elective Hand Surgery Following Axillary Lymph Node Dissection for Breast CancerTHE BREAST JOURNAL, Issue 3 2007Dan D. Hershko MD Abstract:, The development of lymphedema is the most feared complication shared by breast cancer survivors undergoing hand surgery after prior axillary lymph node dissection (ALND). Traditionally, these patients are advised to avoid any interventional procedures in the ipsilateral upper extremity. However, the appropriateness of some of these precautions was recently challenged by some surgeons claiming that elective hand operations can be safely performed in these patients. The purpose of this study was to evaluate our experience and determine the safety of elective hand operations in breast cancer survivors. The medical records of patients operated for different hand conditions after prior breast surgery and ALND at our institution between 1983 and 2002 were reviewed. The techniques and preventive measures performed, use of antibiotics, and upper extremity complications associated with the operations were analyzed. Overall, we operated on 27 patients after prior ALND performed for breast cancer. Follow-up was available for 25 patients. Four patients had pre-existing lymphedema. The surgical technique used was similar to that performed in patients without prior ALND and antibiotic prophylaxis was not given. Delayed wound healing was observed in one patient and finger joint stiffness in another. Two patients with pre-existing lymphedema developed temporary worsening of their condition. None of the patients developed new lymphedema. The results of the present study support the few previous studies, suggesting that hand surgery can be safely performed in patients with prior ALND. Based on these findings, the appropriateness of the rigorous precautions and prohibitions regarding the care and use of the ipsilateral upper extremity may need to be reconsidered. [source] Detection of Micrometastasis in the Sentinel Lymph Node via Lymphoscintigraphy for a Patient With In-Transit Metastatic MelanomaDERMATOLOGIC SURGERY, Issue 9 2003Chih-Hsun Yang MD Background. Lymphoscintigraphy and sentinel lymph node (SLN) biopsy are highly accurate methods of detecting regional lymph node status for melanoma. Previously, these procedures were mainly performed in patients with primary melanoma before wide local excision. Objective. To present a case with in-transit recurrence melanoma using lymphoscintigraphy and SLN biopsy for detection of nodal basin status. Methods. The patient discussed here had a subungual melanoma that developed as an in-transit metastatic melanoma on the pretibia area 2 years after right big toe amputation. By using lymphoscintigraphy and SLN biopsy technique with injection of technetium-99m colloid around the in-transit metastatic site, the first node (SLN) draining the in-transit metastatic tumor was identified and harvested on the right inguinal area. Immediate right inguinal node dissection was subsequently performed. Results. Under thorough histologic examination, the first node (SLN) draining the in-transit metastatic tumor was the only node that contained micrometastatic tumor cells in the surgical specimens. Conclusion. Lymphoscintigraphy and SLN biopsy techniques are sensitive procedures for detecting the regional nodal basin micrometastasis in in-transit recurrence melanoma patients. [source] Cutaneous melanoma: therapeutic lymph node and elective lymph node dissections, lymphatic mapping, and sentinel lymph node biopsyDERMATOLOGIC THERAPY, Issue 6 2005David B. Pharis ABSTRACT:, Early clinical observation in cancer patients suggested that tumors spread in a methodical, stepwise fashion from the primary site, to the regional lymphatics, and only then to distant locations. Based on these observations, the regional lymphatics were believed to be mechanical barriers, at least temporarily preventing the widespread dissemination of tumor. Despite evidence now available disputing its validity, this barrier theory has guided the surgical management of the regional lymphatics in cancer patients for more than a century, influencing the use of such surgical modalities as therapeutic lymph node dissection, elective lymph node dissection, and most recently lymphatic mapping and sentinel lymph node biopsy. No published randomized controlled trial exists that demonstrates improved overall patient survival for cancer of any type, including melanoma, after surgical excision of regional lymphatics. This article will review the biology of lymphatics as it relates to regional tumor metastasis, and based on available information, offer practical recommendations for the clinical dermatologist and their patients who have cutaneous melanoma. [source] ThinPrep Pap test of endocervical adenocarcinoma with lymph node metastasis: Report of a case in a 17-year-old woman,DIAGNOSTIC CYTOPATHOLOGY, Issue 9 2010David G. Wagner M.D. Abstract Endocervical adenocarcinoma is an uncommon malignancy that is composed of multiple subtypes and accounts for ,15% of all cervical cancers. In this article, we describe the cytomorphology and differential diagnosis of an AJCC clinical stage IIIb, FIGO IB2 endocervical adenocarcinoma in a 17-year-old woman in a ThinPrep Pap test. The patient was a 17-year-old G0P0 white woman with no significant past medical history and no prior history of cervical dysplasia. She presented to her physician with a putrid vaginal discharge. A sample was sent to cytology that was interpreted as atypical endocervical cells, favor neoplasia. A subsequent cervical biopsy was diagnosed as endocervical adenocarcinoma with villoglandular features and ultimately, a hysterectomy with lymph node dissection was performed. The final diagnosis was endocervical adenocarcinoma with metastasis to three pelvic lymph nodes. The cytomorphology of endocervical adenocarcinoma on ThinPrep Pap test is similar to that described for conventionally-processed Pap smears. This difficult diagnosis should be considered on a ThinPrep Pap test, regardless of age when the characteristic cytomorphology is observed. On a cytology sample, it is advisable to state atypical endocervical cells, adenocarcinoma in situ, or endocervical adenocarcinoma without providing a specific subtype even if there is a predominance of features for a particular subtype. Diagn. Cytopathol. 2010;38:633,638. © 2009 Wiley-Liss, Inc. [source] EARLY GASTRIC CANCER WITH WIDESPREAD DUODENAL INVASION WITHIN THE MUCOSADIGESTIVE ENDOSCOPY, Issue 3 2010Tsutomu Namikawa We report a rare case of early gastric cancer confined to the mucosal layer with extensive duodenal invasion, curatively removed with distal gastrectomy. An 84-year-old Japanese woman was referred to our hospital with gastric cancer. A barium meal examination and esophagogastroduodenoscopy revealed an irregular nodulated lesion measuring 6.5 x 5.5 cm in the gastric antrum and an aggregation of small nodules in the duodenal bulb. A biopsy specimen showed well-differentiated adenocarcinoma. The patient underwent distal gastrectomy with partial resection of the duodenal region containing the tumor and regional lymph node dissection, with no complication. Histological examination of the resected tissue confirmed well-differentiated adenocarcinoma limited to the mucosal layer and without lymph node metastasis. The cancer extended into the duodenum as far as 38 mm distant from the pyloric ring, and the resected margins were free of cancer cells. Gastric cancer located adjacent to the pyloric ring thus has the potential for duodenal invasion, even when tumor invasion is confined to the mucosal layer. In such cases, care should be taken during examinations to detect duodenal invasion, and the distal surgical margin must be negative given sufficient duodenal resection. [source] Adopting the operating microscope in thyroid surgery: Safety, efficiency, and ergonomics,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 2 2010Bruce J. Davidson MD Abstract Background. Our aim was to assess the safety and efficiency of operating microscope use by surgeons in thyroid surgery to reduce static neck flexion. Methods. A retrospective case review comparing thyroidectomies performed using an operating microscope to those using surgical loupes was done. Operative times and incidence of complications were compared between total thyroidectomy procedures done with either microscope or loupes. Results. The use of microscope in 51 thyroidectomies (including 20 for malignancy with central compartment node dissection [CND] and 9 for substernal goiter [SG]) was compared with 65 cases (15 with CND and 11 with SG) done previously using loupes. Surgical times using the microscope were longer (p = .0001), but the increase was significant only in the subset of patients who underwent thyroidectomy with CND. There was no difference in complications between the groups. Conclusion. The use of an operating microscope during thyroidectomy is safe with modest increases in surgical time. © 2009 Wiley Periodicals, Inc. Head Neck, 2010 [source] Efficacy of diagnostic upper node evaluation during (salvage) laryngectomy for supraglottic carcinomaHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 2 2009Ronald J. E. Pennings MD Abstract Background. The effectiveness of selective upper node dissection or inspection during laryngectomy for supraglottic squamous cell carcinoma was evaluated. These diagnostic procedures aimed to cause less morbidity than elective neck dissection in patients with a clinically N0 neck. Methods. In 93 patients, 166 clinically N0 necks (73 bilateral and 20 contralateral) were evaluated. Lymph nodes at levels II and III were inspected or dissected and directly sent in for frozen section histopathology. This way, occult neck metastases were identified and treated by neck dissection. Results. Occult neck metastases were identified in 19% of the examined necks (31/166). Regional recurrence rate in the postoperative N0 necks was 0%, and 10% in the postoperative N+ necks. Conclusions. Selective upper node dissection and inspection during laryngectomy reduced the need for an elective neck dissection with its morbidity in the clinically N0 neck. In addition, it selects the patients who need such extensive treatment. © 2008 Wiley Periodicals, Inc. Head Neck, 2009. [source] Treatment of the N0 neck during salvage surgery after radiotherapy of head and neck squamous cell carcinomaHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2005Stephane Temam MD Abstract Background. The morbidity and mortality rates of salvage surgery in patients with local recurrence of head and neck squamous cell carcinoma (HNSCC) after radiotherapy are high. The aim of this study was to determine the rate of occult neck node metastasis and the surgical morbidity of patients after salvage surgery for local relapse after definitive radiotherapy. Methods. Thirty patients who underwent salvage surgery with a simultaneous neck node dissection for a local relapse after definitive radiotherapy for HNSCC between 1992 and 2000 were included in this study. The primary tumor sites were oral cavity in six patients, oropharynx in 17, supraglottic larynx in three, and hypopharynx in four. Initially, seven patients had T2 disease, eight had T3, and 15 had T4. Results. Twelve patients (40%) experienced postoperative complications, including two deaths. There was no cervical lymph node metastasis (pN0) in 29 of the 30 patients. Fifteen patients (50%) had a recurrence after salvage surgery, including 11 new local recurrences and four patients with distant metastasis. Conclusions. The risk of neck node metastasis during salvage surgery for local recurrence in patients treated initially with radiation for N0 HNSCC is low. Neck dissection should be performed in only limited area, depending on the surgical procedure used for tumor resection. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Elective treatment of the neck in squamous cell carcinoma of the larynx: Clinical experienceHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 2 2003Giuseppe Spriano MD Abstract Background. In head and neck cancer, the best prophylactic treatment for the N0 neck is a subject of debate. Some authors propose lateral selective lymph node dissection (levels II,IV) on the basis of the probability of finding occult metastases in those lymph nodes. A more extensive procedure including Vth level is considered unnecessary because of the low incidence of metastases in the posterior triangle. Methods. We retrospectively evaluated 346 N0 patients affected by laryngeal carcinoma and consecutively treated at the Department of Otorhinolaryngology of the Ospedale di Circolo, Varese, Italy. The patients underwent elective selective neck dissection (levels II,V) for a total of 602 dissected heminecks. Result. Seventy heminecks (11.6%) were pN+, and in 10 of 70 cases (14.3%) level V was involved; in 5 of 10 metastases were isolated. Conclusion. Our retrospective study confirms the probabilistic criteria of the incidence of occult metastasis by level in laryngeal cancer. On the basis of our data Vth level nodes, although very rarely, 10 of 604 (1.6%), are involved with laryngeal cancer. Our approach to routinely dissect Vth level nodes is discussed. © 2003 Wiley Periodicals, Inc. Head Neck 25: 97,102, 2003 [source] Clinical usage of the squamous cell carcinoma antigen in patients with penile cancerINTERNATIONAL JOURNAL OF UROLOGY, Issue 2 2007Stavros Touloupidis Background: We present our initial experience with the use of the squamous cell carcinoma (SCC) antigen (SCCAg) in 16 men with penile SCC (SCC group), in four men with condyloma acuminatum (benign group), and in 32 blood donors (control group). Methods: The SCCAg levels were measured at presentation and every 6 months (upper limit was 2 ng/mL). The mean follow-up time was 4 years. Results: All non-SCC patients had normal SSCAg serum levels in contrast with the SCC patients. The presence of nodal and/or distant metastases resulted in statistically significant higher SCCAg levels, both at presentation and during the follow-up. In patients undergoing lymph node dissection with elevated SCCAg levels prior to the procedure, there was a statistically significant decrease of the SCCAg levels after the operation. Conclusion: The SCCAg level could be a serum marker that holds promise for clinical use in penile SCC. Sequential monitoring of SCCAg level might indicate developing of nodal and/or distant metastases and could be useful in following the response to treatment. [source] Clinical outcome of retroperitoneal lymph node dissection after induction chemotherapy for metastatic non-seminomatous germ cell tumorsINTERNATIONAL JOURNAL OF UROLOGY, Issue 9 2004MOTOTSUGU MURAMAKI Abstract Background: Retroperitoneal lymph node dissection (RPLND) following induction chemotherapy has been considered a critical component in the comprehensive management of advanced non-seminomatous germ cell tumors (NSGCT). The objectives of the present study were to review the clinical outcome of patients who underwent RPLND and to evaluate the probability of necrosis alone, based on some readily available clinical data for these patients. Methods: Forty-seven consecutive patients with NSGCT were treated with first-line chemotherapy at our institution between January 1993 and September 2002. Twenty-four of these patients, who underwent RPLND with normal values of tumor markers after induction chemotherapy, were included in the study. The cause-specific survival rate was calculated using the Kaplan,Meier method. Various predictive factors for the histology were analyzed using multivariate analysis. Results: The pathological findings at resection were necrosis alone in 62.5% of cases, teratoma in 25.0%, and viable cancer in 12.5%. The cause-specific 3-year survival rate of patients who underwent complete and incomplete resection was 100% and 50.0%, respectively. Among several clinical factors, prechemotherapy tumor size less than 50 mm was found to be an independent predictor of necrosis alone (hazard ratio = 4.45, P= 0.04). Conclusion: Metastatic tumor size before chemotherapy appears to be one of the most important factors for the prediction of necrosis alone in the resected specimens of RPLND. The prognosis of patients might be influenced by the degree to which resection has been completed. [source] Retroperitoneal lymph node dissection in patients with interaortocaval lymph node metastases of transitional cell carcinoma of the urinary tractINTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2004CHUL JANG KIM Abstract Three patients suffered from renal pelvic, ureteral and bladder cancers that were treated with both standard surgical treatments and two adjuvant cycles of cisplatin-based combination chemotherapy. Metastases of interaortocaval lymph nodes were detected in all patients between 9 and 33 months from the surgery for primary lesions. All patients received three cycles of cisplatin-based combination chemotherapy and retroperitoneal lymph node dissection (RPLND). The chemotherapy achieved partial response (62,98%). Two patients with viable cancer cells died with hepatic metastases; the first 15 months and the second 25 months from the date of diagnosis of distant lymph node metastasis. The third patient, who had no viable cancer cells, remains alive and disease-free 36 months later. Therefore, RPLND after chemotherapy provides prognostic information that helps to define patients who might benefit from additional systemic chemotherapy. [source] Electrostimulation of sympathetic nerve fibers during nerve-sparing laparoscopic retroperitoneal lymph node dissection in testicular tumorINTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2003YASUHIRO KAIHO Abstract A long-handled pair of electrodes with sufficient length to allow stimulation during laparoscopic retroperitoneal lymph node dissection (RPLND) was designed at our institute. We clinically utilized this electrode in the treatment of a 37-year-old patient with testicular tumor who underwent right orchidectomy and nerve-sparing laparoscopic RPLND. During laparoscopic RPLND, sympathetic nerve fibers relevant to ejaculation were electrically stimulated and changes in pressure at the bladder neck were observed. Nerve preservation was confirmed by increased pressure at the bladder neck and ejaculation immediately after the electrostimulation. The application of laparoscopic electrostimulation may become widespread, particularly since it meets the increasing demand for minimally invasive surgery. [source] Per-operative frozen section examination of pelvic nodes is unnecessary for the majority of clinically localized prostate cancers in the prostate-specific antigen eraINTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2000Yoshiyuki Kakehi Abstract Background: The incidence of unsuspected lymph node metastasis seems to be decreasing in the prostate-specific antigen (PSA) era. It remains controversial as to whether routine pelvic lymph node dissection and per-operative frozen section examination should be performed. In addition, it is still unclear whether an aggressive approach to local disease by surgery or irradiation confers survival benefits on stage D1 patients. Methods: Eighty-eight consecutive patients with clinically localized prostate cancer who underwent pelvic lymph node dissection prior to radical prostatectomy during the period between 1985 and 1998 were analyzed. The incidence of lymph node metastases after 1992 was compared with that before 1992. Sensitivity and specificity of frozen section examination was assessed. Progression-free survival and cause-specific survival curves of node-positive patients who underwent radical prostatectomy were estimated by the Kaplan,Meier method. Results: Six of 17 patients (35.3%) treated before 1992 and five of 71 patients (7.0%) treated after 1992 showed unsuspected lymph node metastasis (P = 0.0059). Eight of 11 node-positive patients underwent radical prostatectomy and two have so far demonstrated clinical progression and cancer death with a median follow-up period of 63 months. The 5 year progression-free rate and the cause-specific survival rate for these patients were 71.4 and 85.7%, respectively. Sensitivity of frozen section examination for micrometastasis and gross-metastasis cases, respectively, was 3/6 (50%) and 4/4 (100%), while specificity was 85/85 (100%). Conclusions: The incidence of unsuspected lymph node metastases has been significantly decreased in the PSA era. Frozen section examination of pelvic nodes can be omitted and radical prostatectomy is an acceptable choice of treatment in patients without macroscopically apparent nodal metastases. [source] Effectiveness of exercise programmes on shoulder mobility and lymphoedema after axillary lymph node dissection for breast cancer: systematic reviewJOURNAL OF ADVANCED NURSING, Issue 9 2010Dorothy N.S. Chan chan d.n.s., lui l.y.y. & so w.k.w. (2010) Effectiveness of exercise programmes on shoulder mobility and lymphoedema after axillary lymph node dissection for breast cancer: systematic review. Journal of Advanced Nursing,66(9), 1902,1914. Abstract Aim., This article is a report of a review of the effectiveness of exercise programmes on shoulder mobility and lymphoedema in postoperative patients with breast cancer having axillary lymph node dissection, as revealed by randomized controlled trials. Background., Breast cancer is the most common malignancy in women. After surgery, the most common postoperative complications are reduced range of motion in the shoulder, muscle weakness in the upper extremities, lymphoedema, pain and numbness. To reduce these impairments, shoulder exercises are usually prescribed. However, conflicting results regarding the effect and timing of such exercises have been reported. Data sources., Studies were retrieved from a systematic search of published works over the period 2000,2009 indexed in the Cumulative Index to Nursing and Allied Health Literature, Ovid Medline, the British Nursing Index, Proquest, Science Direct, Pubmed, Scopus and the Cochrane Library, using the combined search terms ,breast cancer', ,breast cancer surgery', ,exercise', ,lymphoedema', ,shoulder mobility' and ,randomized controlled trials'. Methods., A quantitative review of effectiveness was carried out. Studies were critically appraised by three independent reviewers, and categorized according to levels of evidence defined by the Joanna Briggs Institute. Results., Six studies were included in the review. Early rather than delayed onset of training did not affect the incidence of postoperative lymphoedema, but early introduction of exercises was valuable in avoiding deterioration in range of shoulder motion. Conclusion., Further studies are required to investigate the optimal time for starting arm exercises after this surgery. Nurses have an important role in educating and encouraging patients to practise these exercises to speed up recovery. [source] Case of mucinous adenocarcinoma with porcelain gallbladderJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 8 2003YOUNG-EUN JOO Abstract Histologically, the majority of gallbladder cancers are adenocarcinomas. Among the adenocarcinomas, the mucinous adenocarcinoma is relatively uncommon. Porcelain gallbladder is a rare finding and the risk of gallbladder cancer is significantly increased in porcelain gallbladder. We describe a rare case of mucinous adenocarcinoma with porcelain gallbladder. A 46-year-old man was admitted to Chonnam National University Hospital with a 2-week history of right upper quadrant pain. Three and 2 years previously, he had two episodes of cholecystitis with gallstones. An abdominal computed tomography revealed a contracted gallbladder with circumferential mural calcification, and the possibility of gallbladder cancer and porcelain gallbladder were considered. At laparotomy, cholecystectomy, liver wedge resection, and radical lymph node dissection were performed. The resected gallbladder showed thickened wall, luminal narrowing and mucosal irregularity. A histological examination of the resected gallbladder showed a mucinous adenocarcinoma composed of poorly differentiated glandular cells with mucin lakes. Porcelain gallbladder may be an end result of a chronic inflammatory reaction, and this change is associated with the development of gallbladder cancer. [source] Increased morbidity rates in patients with heart disease or chronic liver disease following radical gastric surgeryJOURNAL OF SURGICAL ONCOLOGY, Issue 3 2010Sang-Ho Jeong MD Abstract Background The aim of this study was to investigate possible associations between (i) comorbid disease and (ii) perioperative risk factors and morbidity following radical surgery for gastric cancer. Materials and Methods Consecutive patients (759) undergoing radical gastrectomy and D2 level lymph node dissection for gastric cancer were included. Clinical data concerning patient characteristics, operative methods, and complications were collected prospectively. Results The morbidity rate for radical gastrectomy was 14.2% (108/759). The most significant comorbid risk factors for postoperative morbidity were heart disease [anticoagulant medication: OR,=,1.5 (95% CI,=,0.35,6.6, P,=,0.53); history without medication: OR,=,4.0 (95% CI,=,1.1,14.6, P,=,0.03); history with current medication: OR,=,6.7 (95% CI,=,1.5,29.9, P,=,0.01)] and chronic liver disease [chronic hepatitis: OR,=,2.4 (95% CI,=,0.9,6.5, P,=,0.07); liver cirrhosis class A: OR,=,8.4 (95% CI,=,2.8,25.3, P,=,0.00); liver cirrhosis class B: OR,=,9.38 (95% CI,=,0.7,115.5, P,=,0.08)]. The most significant perioperative risk factors for postoperative morbidity were high TNM stage and combined organ resection (P,<,0.05), and there was no association between increased postoperative morbidity and well controlled hypertension, anticoagulant therapy, diabetes mellitus, pulmonary disease, tuberculosis, or thyroid disease (P,>,0.05). Conclusion Patients with heart disease or chronic liver disease are at a higher risk of morbidity following radical surgery for gastric cancer. J. Surg. Oncol. 2010; 101:200,204. © 2010 Wiley-Liss, Inc. [source] Complement of peritumoral and subareolar injection in breast cancer sentinel lymph node biopsyJOURNAL OF SURGICAL ONCOLOGY, Issue 2 2009Masakuni Noguchi MD Abstract Background The optimal site for injection of mapping tracers is controversial in sentinel lymph node (SLN) biopsy for breast cancer. We evaluated whether a combination of peritumoral (PT) injection and subareolar (SA) injection can improve the identification rate of SLN biopsy and decrease the false-negative rate. Methods Two hundred one patients underwent SLN biopsy with PT injection of radioisotope and SA injection of blue dye. Results The overall identification rate for blue and/or hot lymph nodes was 99.5%; the identification rate of blue-dyed lymph nodes was 98.0% and that of hot lymph nodes was 97.0%. However, no concordance between the hot node and the blue node was found in 17 patients (8.5%). Among SLN-positive 51 patients, 4 patients had blue-only positive SLN and 7 had hot-only positive SLN. Consequently, the false-negative rates were at least 7.8% for PT injection and 13.7% for SA injection, while axillary lymph node dissection was not performed in SLN-negative patients. However, a combination of both injections significantly decreased the false-negative rate. Conclusions The success of SLN mapping is optimized not only by using dye and isotope in combination but also by using PT and SA injections in combination. J. Surg. Oncol. 2009;100:100,105. © 2009 Wiley-Liss, Inc. [source] The effect of spleen-preserving lymphadenectomy on surgical outcomes of locally advanced proximal gastric cancerJOURNAL OF SURGICAL ONCOLOGY, Issue 5 2009Sung Jin Oh MD Abstract Background The aim of this study was to investigate the effects of D2 lymphadenectomy with spleen preservation on surgical outcomes in locally advanced proximal gastric cancer. Methods Between January 2000 and December 2004, a total of 366 patients who underwent curative total gastrectomy were studied retrospectively from a prospectively designed database. Results The spleen-preservation group experienced shorter operation times, a lower incidence of perioperative transfusion, and shorter postoperative hospital stays. Perioperative transfusion and splenectomy were independent risk factors for morbidity. There was no significant difference between the two groups in recurrence or cumulative survival rate when adjusted according to cancer stage. Multivariate analysis showed that tumor size, serosal invasion, and nodal metastasis were independent prognostic factors, while splenectomy was not. The cumulative survival rate in pN0-status patients was significantly higher in the spleen-preservation group, while there was no significant difference in the survival of pN1- or pN2-status patients between the two groups. Conclusions Splenectomy for lymph node dissection in proximal gastric cancer patients obviously showed poor short-surgical outcomes, but it did not affect long-term outcomes in terms of recurrence and overall survival rate. Therefore, spleen-preserving lymphadenectomy is a feasible method for radical surgery in locally advanced proximal gastric cancer. J. Surg. Oncol. 2009;99:275,280. © 2009 Wiley-Liss, Inc. [source] Added value of ultrasound in screening the clinically negative axilla in breast cancerJOURNAL OF SURGICAL ONCOLOGY, Issue 5 2006I.M.J. Mathijssen MD Abstract Background For staging purposes in breast cancer it is current practice to perform a sentinel node biopsy in a clinically negative axilla, followed by an axillary lymph node dissection if metastases are found in the sentinel node. To limit the number of surgical procedures it is therefore of importance to try and identify as much patients as possible who have axillary metastases. Clinical staging of the axillary nodes in breast cancer is mainly based on palpation, but ultrasound has been shown to be of additional value in detecting pathological nodes. Methods In this paper, we report our results of screening 131 breast cancer patients without palpable axillary nodes through ultrasound. Results Out of the 53 patients with axillary node involvement, 18 were identified as such by our radiologist, resulting in a detection score of 34%. Discussion This high rate is probably reached because of the limited number of radiologists performing this procedure, thereby rapidly increasing their experience. J. Surg. Oncol. 2006;94:364,367. © 2006 Wiley-Liss, Inc. [source] Interpectoral approach to dissection of the Axillary Apex: An elegant and effective approachJOURNAL OF SURGICAL ONCOLOGY, Issue 3 2006Ajit Pai MS Abstract Background Axillary dissection is the goldstandard for treatment of the axilla. It provides important prognostic information, accurately stages the axilla, and has the lowest recurrence rate among all modalities. In today's age of conservation surgery, the axilla is often addressed through a cosmetically acceptable small incision with limited access, thereby making clearance of the level III nodes difficult. Methods We describe a method of apical lymph node dissection through the interpectoral plane, which effectively clears the apex despite the constraints of limited exposure. Results This method has been used in nearly 5,000 axillary dissections performed at our institute, with excellent results. It preserves the innervation of the pectoral muscles and affords access to the interpectoral nodes. Conclusions Our method has a short learning curve, provides good exposure of a difficult area and consistently provides a good yield of nodes. J. Surg. Oncol. 2006;94:252,254. © 2006 Wiley-Liss, Inc. [source] Symmetrization reduction mammaplasty combined with sentinel node biopsy in patients operated for contralateral breast cancerJOURNAL OF SURGICAL ONCOLOGY, Issue 1 2006Peter Schrenk MD Abstract Background and Objectives: Occult invasive cancer found in reduction mammaplasty specimen in the contralateral breast in breast cancer patients requires axillary lymph node dissection (ALND) to assess the lymph node status. Routine Sentinel node (SN) biopsy in these patients may avoid secondary ALND when an occult cancer is found and the SN is negative in the permanent histological examination. Methods: One hundred sixty-nine breast cancer patients underwent contralateral reduction mammaplasty for symmetrization and with SN biopsy of the non-cancer breast. SN mapping was done using a vital blue dye alone (n,=,136) or in combination with a radiocolloid (n,=,33). Results: A mean number of 1.4 SNs (range 1,3 SNs) was identified in 158 of 169 patients (identification rate 93.5%). One of 158 patients revealed a positive SN but no tumor was found in the reduction mammaplasty/mastectomy specimen, whereas the SN was negative in 157 patients. Histological examination of the 169 reduction mammaplasty specimen revealed 5 occult invasive cancers and 4 patients with high grade DCIS but due to a negative SN biopsy the patients were spared a secondary ALND. Conclusion: The small number of patients with occult contralateral cancers may not warrant routine SN mapping in patients scheduled for contralateral reduction mammaplasty. J. Surg. Oncol. 2006;94:9,15. © 2006 Wiley-Liss, Inc. [source] Re: A prospective trial for avoiding cervical lymph node dissection for thoracic esophageal cancers, based on intra-operative genetic diagnosis of micrometastasis in recurrent laryngeal nerve chain nodes, by Miyata H, Yano M, Doki Y, et al.JOURNAL OF SURGICAL ONCOLOGY, Issue 6 2006FRCSC, Jocelyne Martin MD No abstract is available for this article. [source] Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: A phase II study following the learning curveJOURNAL OF SURGICAL ONCOLOGY, Issue 1 2005Michitaka Fujiwara MD Abstract Background and Objectives A preliminary study on the use of laparoscopy-assisted approach to treat gastric carcinoma resulted in higher morbidity. Study Design A prospective phase II study of laparoscopy-assisted distal gastrectomy (LADG) was performed for patients with preoperative diagnosis of T1 N0 stage cancer located in the lower or middle-third stomach. Bleeding amount, operating time, mortality, morbidity, and the number of lymph node retrieval were recorded and compared with the preliminary series reported previously by the same authors. Results Between 2000 and 2002, 47 patients were accrued. The mean blood loss and postoperative hospital stay were significantly decreased compared with the previous series, whereas the operating time was not. There were no in-hospital deaths, with the incidence of anastomotic leakage significantly decreased. All patients remain disease-free to date. Conclusions LADG can be performed safely and morbidity, no longer, is a drawback by experienced hands that have reached plateau of the learning curve, although it remains a time-consuming procedure. Its application to gastric cancer surgery is feasible for early stage cancer, and its applicability to the treatment of T2 stage cancer will be the next issue to be explored. J. Surg. Oncol. 2005;91:26,32. © 2005 Wiley-Liss, Inc. [source] Intrahepatic cholangiocarcinoma diagnosed preoperatively as hepatocellular carcinomaJOURNAL OF SURGICAL ONCOLOGY, Issue 2 2004Masakazu Yamamoto MD Abstract Background Some cases of mass-forming intrahepatic cholangiocarcinoma (ICC) are diagnosed as hepatocellular carcinoma (HCC) based on preoperative imaging and clinical findings. We investigated the backgrounds of such cases. Methods Sixty-seven patients with mass-forming ICC underwent surgery from 1980 to 2002. Twenty-four of these patients received a diagnosis of HCC preoperatively. We compared the group diagnosed as HCC and that diagnosed as ICC. ICC was diagnosed histopathologically in all 67 patients. Results The specific clinical findings included high rates of associated hepatitis C virus infection, high levels of serum alpha fetoprotein, lower levels of serum CA19-9, small dimension of the tumor, hypervascular staining on angiography or computed tomography, lower rates of lymph node metastasis, and high rates of HCC occurrence in the group diagnosed as HCC. None of the patients underwent extrahepatic bile duct resection and most patients did not undergo lymph node dissection in the group diagnosed as HCC. The rates of mucus secretion and the ductal expression of mucin core protein-1 (MUC1) were significantly different between the subgroups. The cumulative survival rates were significantly better in the group diagnosed as HCC than in the group diagnosed as ICC. Conclusion Patients with ICC given a preoperative diagnosis of HCC had distinct clinical features and could be treated with the same operation as HCC patients. J. Surg. Oncol. 2004;87:80,83. © 2004 Wiley-Liss, Inc. [source] Variability in axillary lymph node dissection for breast cancer,,JOURNAL OF SURGICAL ONCOLOGY, Issue 1 2004Michael Schaapveld MSc Abstract Background The axillary nodal status may influence the prognosis and the choice of adjuvant treatment of individual breast cancer patients. The variation in number of reported axillary lymph nodes and its effect on the axillary nodal stage were studied and the implications are discussed. Methods Between 1994 and 1997, a total of 4,806 axillary dissections for invasive breast cancers in 4,715 patients were performed in hospitals in the North-Netherlands. The factors associated with the number of reported nodes and the relation of this number with the nodal status and the number of positive nodes were studied. Results The number of reported nodes varied significantly between pathology laboratories, the median number of nodes ranged from 9 to 15, respectively. The individual hospitals explained even more variability in the number of nodes than pathology laboratories (range in median number 8,15, P,<,0.0001). The number of reported nodes increased gradually during the study period. A decreasing trend was observed with older patient age. A higher number of reported nodes was associated with a markedly increased chance of finding tumor positive nodes, especially more than three nodes. The frequency of node positivity increased from 28% if less than six nodes to 54% if ,20 nodes were examined, the percentage of tumors with ,4 positive nodes increased from 4 to 31%. Multivariate analysis confirmed these results. Conclusions This population-based study showed a large variation in the number of reported lymph nodes between hospitals. A more extensive surgical dissection or histopathological examination of the specimen generally resulted in a higher number of positive nodes. Although the impact of misclassification on adjuvant treatment will have varied, the impact with regard to adjuvant regional radiotherapy may have been considerable. J. Surg. Oncol. 2004;87:4,12. © 2004 Wiley-Liss, Inc. [source] Lymphoscintigraphic and intraoperative detection of the sentinel lymph node in breast cancer patients: The nuclear medicine perspectiveJOURNAL OF SURGICAL ONCOLOGY, Issue 3 2004Giuliano Mariani MD Abstract The concept of sentinel lymph node biopsy in breast cancer surgery relates to the fact that the tumor drains in a logical way via the lymphatic system, from the first to upper levels. Therefore, (1) the first lymph node met (the sentinel node) will most likely be the first one affected by metastasis, and (2) a negative sentinel node makes it highly unlikely that other nodes are affected. Sentinel lymph node biopsy would represent a significant advantage as a mini-invasive procedure, considering that, after operation, about 70% of patients are found to be free from metastatic disease, yet axillary node dissection can lead to significant morbidity. Although the pattern of lymphatic drainage from a breast cancer can be very variable, the mammary gland and the overlying skin can be considered as a biologic unit in which lymphatics tend to follow the vasculature. Considering that tumor lymphatics are disorganized and relatively ineffective, subdermal, and peritumoral injection of small aliquots of radiotracer is preferred to intratumoral administration. 99mTc-labeled colloids with most of the particles in the 100,200 nm size range would be ideal for radioguided sentinel node biopsy in breast cancer. Lymphoscintigraphy is an essential part of radioguided sentinel lymph node biopsy, as images are used to direct the surgeon to the site of the node. The sentinel lymph node should have a significantly higher count than background. After removal of the sentinel node, the axilla must be re-examined to ensure all radioactive sites are identified and removed for analysis. The success rate of radioguidance in localizing the sentinel lymph node in breast cancer surgery is about 94,97% in Institutions where a high number of procedures are performed, approaching 99% when combined with the vital blue dye technique. At present, there is no definite evidence that a negative sentinel lymph node biopsy is invariably correlated with a negative axillary status, except perhaps for T1a-b breast cancers, with size ,1 cm. Randomized clinical trials should elucidate the impact of avoiding axillary node dissection in patients with a negative sentinel lymph node on the long-term clinical outcome of patients. J. Surg. Oncol. 2004;85:112,122. © 2004 Wiley-Liss, Inc. [source] Association between extent of axillary lymph node dissection and patient, tumor, surgeon, and hospital factors in patients with early breast cancerJOURNAL OF SURGICAL ONCOLOGY, Issue 2 2003David W. Petrik MD Abstract Background and Objectives Axillary lymph node dissection (ALND) in patients with breast cancer is crucial for accurate staging, provides excellent regional tumor control, and is included in the standard of care for the surgical treatment of breast cancer. However, the extent of ALND varies, and the extent of dissection and the number of lymph nodes that comprise an optimal axillary dissection are under debate. Despite conflicting evidence, several studies have shown that improved survival is correlated with more lymph nodes removed in both node-negative and node-positive patients. The purpose of this study is to determine which patient, tumor, surgeon, and hospital characteristics are associated with the number of nodes excised in early breast cancer patients. Methods A random sample of 938 women with node-negative breast cancer was drawn from the Ontario Cancer Registry and the data supplemented with chart reviews. The extent of axillary dissection was studied by examining the number of nodes examined in relation to the patient, tumor, surgeon, and hospital factors. Results The mean number of lymph nodes excised was 9.8 (SD = 4.8; range, 1,31), and 49% of patients had ,10 nodes excised. Lower patient age was associated with the excision of more lymph nodes (,10 nodes: 63% of patients <40 years vs. 38% of patients ,80 years). Surgeon academic affiliation and surgery in a teaching hospital were highly correlated with each other and were significantly associated with the excision of ,10 nodes. The number of nodes excised was not associated with any tumor factors, nor with the breast operation performed. These results were confirmed with multivariable models. Conclusions Even though the number of lymph nodes found in the pathologic specimen can be influenced by factors other than surgical technique (e.g., number of nodes present, specimen handling, and pathologic examination), this study shows significant variation of this variable and an association with several patient and surgeon/hospital factors. This variation and the association with survival warrant further study and effort at greater consistency. J. Surg. Oncol. 2003;82:84,90. © 2003 Wiley-Liss, Inc. [source] Merkel cell carcinoma: a clinicopathological study of 11 casesJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 5 2005E Acebo ABSTRACT Objective, To report our 12-year experience with Merkel cell carcinomas (MCCs) from a clinical and pathological point of view. Subjects and setting, Eleven MCCs were diagnosed at our institution between 1991 and 2002. Methods, A retrospective clinical, histopathological and immunohistochemical study was performed. Age, gender, location, size, stage, treatment and follow-up data were collected. Histopathological pattern and immunohistochemical study with CAM 5.2, cytokeratin 20 (CK20), CK7, Ber EP4, neurofilaments, synaptophysin, chromogranin, S100 protein, p53 protein, CD117, leucocyte common antigen (LCA) and Ki-67 were accomplished. Results, Six females and five males with a mean age of 82 years were identified. Tumours were located on the face (n = 6), extremities (n = 3) and trunk (n = 1). At diagnosis, one patient was in stage Ia, six in stage Ib, three in stage II and one in stage III. All but one patient experienced wide surgical excision of the tumour. Additional treatment consisted of lymph node dissection in two patients, radiotherapy in four patients and systemic chemotherapy in one patient. Local recurrence developed in five patients. Three patients died because of MCC after 14 months of follow-up. Intermediate-size round cell proliferation was found in all cases. Additional small-size cell pattern and trabecular pattern were observed in seven and six cases, respectively. Eccrine and squamous cell differentiation were found in three cases. A dot-like paranuclear pattern was observed in all cases with CAM 5.2 and neurofilaments, and in 89% of cases with CK20. Seventy-five per cent of cases reacted with Ber EP4, chromogranin and synaptophysin, 70% with p53, 22% with S100 protein, 55% with CD117 and none with LCA. Ki-67 was found in 75% of tumoral cells on average. Fifty per cent of MCCs reacted with CK7 and showed eccrine differentiation areas. Conclusions, MCC is an aggressive neuroendocrine tumour of the elderly. Wide surgical excision is the recommended treatment. Lymph node dissection, adjuvant radiotherapy and chemotherapy decrease regional recurrences but have not been demonstrated to increase survival. Immunohistochemically, MCC is an epithelial tumour with neuroendocrine features. [source] | ||||||||||||||||||||||||||||||||||