FA04.02: JAPANESE MULTICENTER PROSPECTIVE STUDY FOR ESOPHAGOGASTRIC JUNCTION CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 8-8
Author(s):  
Shinji Mine ◽  
Yukinori Kurokawa ◽  
Hiroya Takeuchi ◽  
Takeshi Sano ◽  
Masanori Terashima ◽  
...  
Keyword(s):  
Lymph Node ◽  
Prospective Study ◽  
Renal Vein ◽  
Esophagogastric Junction ◽  
Left Renal Vein ◽  
The Other ◽  
Celiac Axis ◽  
Esophageal Invasion ◽  
Multicenter Prospective Study ◽  
Upper Mediastinum

Abstract Background Lymph node metastasis from esophagogastric junction (EGJ) cancer is multi-directional, and the previously reported incidences in each nodal station are heavily biased by different operative approaches. We conducted a multicenter prospective study using a standardized surgical protocol of lymphadenectomy. Methods This study is a single-arm, multi-institutional, prospective study. Patients with resectable cT2–4 EGJ cancer were eligible, regardless of neoadjuvant therapy. The primary endpoint was the metastasis rate of each lymph nodal station. The planned sample size was 360, and the entry period was 4 years. Protocol of surgical procedure: Patients diagnosed as having EGJ adenocarcinoma with esophageal invasion > 3 cm or with upper/middle mediastinal lymph node involvement, or those having EGJ squamous cell carcinoma, underwent an esophagectomy via right thoracotomy or thoracoscopy. The lymphadenectomy included the upper/middle/lower mediastinum, paracardiac region, around the celiac axis, and the left renal vein area (16a2lat). Patients with EGJ adenocarcinoma with esophageal invasion ≤ 3 cm underwent transhiatal lower esophagectomy and gastrectomy with lymphadenectomy of the lower mediastinum, paracardiac region, around the celiac axis, and 16a2lat. Results From April 2014 to September 2017, 371 patients were enrolled in this study from 42 institutions. As 8 patients were excluded due to protocol violations and later refusals, 363 patients were analyzed finally. Of 363 patients, 332 (91.4%) had adenocarcinoma and 31 (8.5%) had SCC. 86 patients (23.7%) had cT2 tumors and the other 277 (76.3%) had cT3–4 tumors. 134 patients (36.9%) had cN0 and the other 229 (63.1%) had cN + disease. Neo-adjuvant treatments (mostly chemotherapy) were given to only 121 patients (33.3%). Esophagectomies were performed in 121 patients (33.3%) and extended gastrectomies were performed in 236 (65.0%). Resection with R0 was achieved in 339 (93.4%). Based on histological examinations, the incidences of nodal involvements in each area were as follows: upper mediastinum (9/118, 7.6%); middle mediastinum (14/128, 10.9%); lower mediastinum (47/353, 13.3%); abdominal (240/358, 67.0%); the left renal vein area (16A2lat) (18/344, 5.2%). Conclusion For patients with EGJ cancers, the incidences of nodal involvements in the upper mediastinum and the left renal vein area (16A2lat) were lower than our expectations. Disclosure All authors have declared no conflicts of interest.

Vascular anomalies in patients undergoing retroperitoneal lymph node dissection.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 382-382
Author(s):  
Andrea K. Thissen ◽  
Daniel Porres ◽  
David J. K. P. Pfister ◽  
Charlotte Piper ◽  
Axel Heidenreich
Keyword(s):  
Lymph Node ◽  
Renal Vein ◽  
Left Renal Vein ◽  
Germ Cell Tumors ◽  
Vena Cava ◽  
Vascular Anomalies ◽  
Retroperitoneal Lymph Node Dissection ◽  
Testis Cancer ◽  
Renal Veins ◽  
Retroperitoneal Lymph Node

382 Background: Anomalies of the renal vessels usually are clinically silent and might depicted during CT scanning of the abdomen for staging purposes of urological malignancies. Awareness of these rare anomalies is crucial especially in patients undergoing staging for germ cell tumors in order to avoid overstaging and unnecessary therapy. We report on the incidence of renal vessel anomalies in an unselected group of patients undergoing retroperitoneal lymph node dissection (RPLND) for testis cancer. Methods: 245 patients with testicular germ cell tumors underwent primary or secondary RPLND following inductive chemotherapy. Prior to RPLND, all patients underwent abdominal staging by CT scans or by MRI in selected cases. CT scans were reviewed with regard to the detection of vascular anomalies of the vena cava inf., renal veins, renal arteries, and iliac vessels. CT findings were correlated with intraoperative findings. Results: Overall, vascular anomalies were encountered in 39 patients (15.9%): retroaortic left renal vein in 10 (4.1%), circumaortic left renal vein in two (0.8%), reduplication of the common iliac vein in one (0.4%), accessory renal arteries in 14 (5.7%), thrombosis of the inferior vena cava in 12 (4.9%) patients with IIC disease. Anomalies of the renal vein were detected in 10 out of 12 (83%), in two cases venous anomalies were falsely diagnosed as lymph node disease in stage I NSGCT. All arterial anomalies were identified preoperatively. CT scan identified caval thrombosis in only eight cases (68%), four cases were identified by an additional MRI of the abdomen. Conclusions: Vascular anomalies are frequently encountered in patients with RPLND for testis cancer and have to be acknowledged during surgery even with negative imaging studies. Retroaortic renal veins represent a potential pitfall of CT imaging resulting in unnecessary therapy; it should be considered in pts with CT suspicious lymph nodes caudal to the renal hilus. IVC thrombosis is associated with advanced disease and is best diagnosed by MRI of the abdomen.

scholarly journals Mapping Patterns of Para-aortic Lymph Node Recurrence in Cervical Cancer: A Retrospective Cohort Analysis

2021 ◽  
Author(s):  
Bong Kyung Bae ◽  
Shin-Hyung Park ◽  
Shin Young Jeong ◽  
Gun Oh Chong ◽  
Mi Young Kim ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Superior Mesenteric Artery ◽  
Cancer Patients ◽  
Renal Vein ◽  
Mesenteric Artery ◽  
Left Renal Vein ◽  
Cohort Analysis ◽  
Radiation Therapy Oncology Group ◽  
Aortic Lymph Node

Abstract Background: To map anatomic patterns of para-aortic lymph node (PALN) recurrence in cervical cancer patients and validate currently available guidelines on PA clinical target volumes (CTV).Methods: Cervical cancer patients who developed PALN recurrence were included. The PALNs were classified as left-lateral para-aortic (LPA), aorto-caval (AC), and right para-caval (RPC). Four PA CTVs were contoured for each patient to validate PALN coverage. CTVRTOG was contoured based on the Radiation Therapy Oncology Group guideline. CTVK was contoured as proposed by Keenan et al. CTVM was contoured by expanding symmetrical margins around the aorta and inferior vena cava of 7 mm up to the T12–L1 interspace. CTVnew was created by modifying CTVRTOG to obtain better coverage.Results: We identified 92 PALNs in 35 cervical cancer patients. 46.8% of the PALNs were at LPA, 38.0% were at AC, and 15.2% were at RPC areas. CTVRTOG, CTVK, and CTVM covered 87.0%, 88.0%, and 62.0% of all PALNs, respectively. PALN recurrence above the left renal vein was associated with PALN involvement at diagnosis (p = 0.043). Extending upper border to the superior mesenteric artery allowed the CTVnew to cover 96.7% of all PALNs and all nodes in 91.4% of patients.Conclusion: CTVRTOG and CTVK encompassed most PALN recurrences. For high-risk patients, such as those having PALN involvement at diagnosis, extending the superior border of CTV from the left renal vein to superior mesenteric artery could be considered.

scholarly journals Mapping patterns of para-aortic lymph node recurrence in cervical cancer: a retrospective cohort analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Bong Kyung Bae ◽  
Shin-Hyung Park ◽  
Shin Young Jeong ◽  
Gun Oh Chong ◽  
Mi Young Kim ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Superior Mesenteric Artery ◽  
Cancer Patients ◽  
Renal Vein ◽  
Mesenteric Artery ◽  
Left Renal Vein ◽  
Cohort Analysis ◽  
Radiation Therapy Oncology Group ◽  
Aortic Lymph Node

Abstract Background To map anatomic patterns of para-aortic lymph node (PALN) recurrence in cervical cancer patients and validate currently available guidelines on PA clinical target volumes (CTV). Methods Cervical cancer patients who developed PALN recurrence were included. The PALNs were classified as left-lateral para-aortic (LPA), aorto-caval (AC), and right para-caval (RPC). Four PA CTVs were contoured for each patient to validate PALN coverage. CTVRTOG was contoured based on the Radiation Therapy Oncology Group guideline. CTVK was contoured as proposed by Keenan et al. CTVM was contoured by expanding symmetrical margins around the aorta and inferior vena cava of 7 mm up to the T12–L1 interspace. CTVnew was created by modifying CTVRTOG to obtain better coverage. Results We identified 92 PALNs in 35 cervical cancer patients. 46.8% of the PALNs were at LPA, 38.0% were at AC, and 15.2% were at RPC areas. CTVRTOG, CTVK, and CTVM covered 87.0%, 88.0%, and 62.0% of all PALNs, respectively. PALN recurrence above the left renal vein was associated with PALN involvement at diagnosis (p = 0.043). Extending upper border to the superior mesenteric artery allowed the CTVnew to cover 96.7% of all PALNs and all nodes in 91.4% of patients. Conclusion CTVRTOG and CTVK encompassed most PALN recurrences. For high-risk patients, such as those having PALN involvement at diagnosis, extending the superior border of CTV from the left renal vein to superior mesenteric artery could be considered.

scholarly journals Anatomical characteristics of the left suprarenal vein (V. suprarenalis sinistra)

2013 ◽  
Vol 19 (4) ◽  
pp. 218-222
Author(s):  
S. Popescu ◽  
D.M. Iliescu ◽  
P. Bordei
Keyword(s):  
Renal Vein ◽  
Left Renal Vein ◽  
Left Kidney ◽  
The Other ◽  
Study Methods ◽  
Anatomical Characteristics ◽  
Gonadal Vein ◽  
Plastic Injection ◽  
Anterolateral Aspect

Abstract Our study was performed on 82 cases, using as study methods the dissection and the plastic injection (Technovit 7143) followed by NaOH corrosion. The suprarenal vein traject was always straight, presenting two aspects: in 54.55 % of cases it was an oblique infero-medial traject and in 45.45 % of cases it was a vertical traject. The traject of the left gonadal vein was oblique supero-medial in 55.56 % of the cases and in 44.44 % of cases was vertical. Unlike the corresponding suprarenal vein, the left gonadal vein showed, in 19.44 % of cases, a sinuous traject. Regarding the left suprarenal vein termination site, we found that in 24 cases (50 % of cases), the suprarenal vein was lateral to the aorta, in 41.67 % of cases being closer to the aorta and 8.33 % of cases halfway aorta-left kidney. In the other 24 cases, the left suprarenal vein ends into the left renal vein in front of the aorta, in 25 % of cases on the anterolateral face of the aorta and in 33.33 % of cases closer to the midline; in one case this termination was right beyond the middle of the anterior face of the aorta. The termination of the left gonadal vein was assessed in 75 % of cases on the aortic side, in 37.5 % of cases being closer to the aorta and also in 37.5% of all cases being halfway aorta-left kidney. In 25% of the cases the left gonadal vein ended in into the renal vein on its anterolateral aspect. Comparing the renal termination of the suprarenal and gonadal veins we found that in 29.27 % of cases they ended at the same level, but in only 7.32 % of cases both veins had a vertical traject. In 60.97 % of the cases the gonadal vein ends lateral to the suprarenal vein and only in 9.76 % of the cases the gonadal vein ends medial to the suprarenal vein. We did not found the termination of the suprarenal and gonadal veins closer to kidney or the left gonadal vein end on the anterior face of the aorta.

scholarly journals Surgical treatment strategy for esophagogastric junction cancers based on the tumor diameter

BMC Surgery ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Isamu Hoshino ◽  
Hisashi Gunji ◽  
Fumitaka Ishige ◽  
Yosuke Iwatate ◽  
Nobuhiro Takiguchi ◽  
...  
Keyword(s):  
Tumor Size ◽  
Esophagogastric Junction ◽  
Survival Rates ◽  
Tumor Diameter ◽  
Clinical Factors ◽  
Number Of Patients ◽  
Nodal Dissection ◽  
Esophageal Invasion ◽  
Upper Mediastinum ◽  
Average Tumor Size

Abstract Background The number of patients with esophagogastric junction (EGJ) cancers has tended to increase. However, no clear consensus on the optimum treatment policy has yet been reached. Methods This study included patients diagnosed with adenocarcinoma of Sievert type II in whom resection was performed in our hospital. We performed a clinicopathological examination, and patients were divided into two groups by the tumor size: L group, tumor size ≥4 cm; and S group, tumor size < 4 cm. The clinical factors, such as nodal dissection and recurrence pattern, were then analyzed. Results A total of 48 patients were diagnosed with ECJ cancers. The average tumor size was 55.1 mm, and 32 cases (66.7%) had tumors ≥4 cm. Metastasis to the mediastinum was noted in 4 cases (12.5%) in the L group but none in the S group. Recurrence in the upper or middle mediastinum lymph nodes was noted in 3 cases (9.4%) in the L group. The 5-year overall survival rates were 49.7 and 83.9% in the L and S groups, respectively. Conclusions As the tumor grows large, it is difficult to accurately judge EGJ on the image, and as a result it is difficult to understand the exact esophageal invasion distance of the tumor. Therefore, lymph node dissection including the upper mediastinum is considered vital, regardless of the degree of esophageal invasion.

scholarly journals Prognostic performance of different lymph node staging systems after curative resection for Siewert type II adenocarcinoma of the esophagogastric junction

2020 ◽  
Author(s):  
Weilin Zhang ◽  
Yong Li
Keyword(s):  
Lymph Node ◽  
Esophagogastric Junction ◽  
Curative Resection ◽  
Staging System ◽  
The Other ◽  
Type Ii ◽  
Siewert Type ◽  
Prognostic Performance ◽  
Siewert Type Ii ◽  
Staging Systems

Abstract Background: The tumor-node-metastasis (TNM) pN stage, which is based on the number of positive lymph nodes (LNs), is an important prognostic factor for patients with adenocarcinoma of the esophagogastric junction (AEG). The lymph node ratio (LNR) and log odds of metastatic lymph nodes (LODDS) staging systems are new effective indicators of prognosis. We aimed to evaluate their prognostic value in Siewert type II AEG.Methods: Patients diagnosed with Siewert type II AEG who underwent curative resection between 2004 and 2014 at Guangdong General Hospital were recruited. A Cox regression model was constructed, and prognostic performance was measured using Harrell’s concordance index (C-index) and the Akaike information criterion (AIC).Results: When LN status was modeled as a continuous variable, the LODDS system (C-index: 0.729; AIC: 940.483) outperformed the other staging systems, including the number of positive LNs (LNP) (C-index: 0.721; AIC: 946.935) and LNR (C-index: 0.725; AIC: 938.918).However,when assessed as categorical variables, the LNR staging system had a better prognostic performance (C-index: 0.752; AIC: 926.350) than the American Joint Committee on Cancer (AJCC) 8th edition TNM pN (C-index: 0.740; AIC: 934.349) and LODDS (C-index: 0.737; AIC: 939.087) staging systems. Each LNR stage is more evenly distributed than the other two staging systems. Moreover, the LODDS stage is more dependent on the TLNE.Conclusion: The LNR represented the best prognostic factor when assessed as a categorical variable and may serve as an alternative nodal staging system for AEG.

V484: Laparoscopic Spleno-Renal Venous Bypass for Left Renal Vein Nutcracker Syndrome

2007 ◽  
Vol 177 (4S) ◽  
pp. 161-162
Author(s):  
Benjamin I. Chung ◽  
Monish Aron ◽  
Nicholas J. Hegarty ◽  
Inderbir S. Gill
Keyword(s):  
Renal Vein ◽  
Left Renal Vein ◽  
Nutcracker Syndrome ◽  
Venous Bypass
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