Surgical Management of Patients with Neuroendocrine Neoplasms of the Appendix: Appendectomy or More

2017 ◽  
Vol 106 (3) ◽  
pp. 242-251 ◽  
Author(s):  
Nikhil Pawa ◽  
Ashley K. Clift ◽  
Helai Osmani ◽  
Panagiotis Drymousis ◽  
Andrzej Cichocki ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastases ◽  
Residual Disease ◽  
Disease Recurrence ◽  
Right Hemicolectomy ◽  
Neuroendocrine Neoplasms ◽  
Number Of Patients ◽  
Node Metastases ◽  
Current Guidelines

Background: Appendiceal neuroendocrine neoplasms (ANEN) are mostly indolent tumours treated effectively with simple appendectomy. However, controversy exists regarding the necessity of oncologic right hemicolectomy (RH) in patients with histologic features suggestive of more aggressive disease. We assess the effects of current guidelines in selecting the surgical strategy (appendectomy or RH) for the management of ANEN. Methods/Aims: This is a retrospective review of all ANEN cases treated over a 14-year period at 3 referral centres and their management according to consensus guidelines of the European and the North American Neuroendocrine Tumor Societies (ENETS and NANETS, respectively). The operation performed, the tumour stage and grade, the extent of residual disease, and the follow-up outcomes were evaluated. Results: Of 14,850 patients who had appendectomies, 215 (1.45%) had histologically confirmed ANEN. Four patients had synchronous non-ANEN malignancies. One hundred and ninety-three patients had index appendectomy. Seventeen patients (7.9%) had lymph node metastases within the mesoappendix. Forty-nine patients underwent RH after appendectomy. The percentages of 30-day morbidity and mortality after RH were 2 and 0%, respectively. Twelve patients (24.5%) receiving completion RH were found to have lymph node metastases. Two patients had liver metastases, both of them synchronous. The median follow-up was 38.5 months (range 1-143). No patient developed disease recurrence. Five- and 10-year overall survival for all patients with ANEN as the only malignancy was both 99.05%. Conclusions: The current guidelines appear effective in identifying ANEN patients at risk of harbouring nodal disease, but they question the oncological relevance of ANEN lymph node metastases. RH might present an overtreatment for a number of patients with ANEN.

scholarly journals Residual disease in lymph nodes has no influence on survival in patients with incidental gallbladder cancer – institution experience with literature review

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Mihajlo Đokic ◽  
Urban Stupan ◽  
Sabina Licen ◽  
Blaz Trotovsek
Keyword(s):  
Lymph Node ◽  
Survival Rate ◽  
Lymph Nodes ◽  
Gallbladder Cancer ◽  
Lymph Node Metastases ◽  
Residual Disease ◽  
Treatment Strategies ◽  
Node Metastases ◽  
Incidental Gallbladder Cancer

Abstract Background A better appreciation of the course and factors that influence incidental gallbladder cancer (iGBC) is needed to develop treatment strategies aimed to improve outcomes. The purpose of the study was to determine the influence of residual disease in the liver and lymph nodes on overall survival in re-resected patients with iGBC. Patients and methods Patients undergoing radical re-resection for iGBC from January 2012 to December 2018 were retrospectively identified. Patients with a 5-year follow-up and submitted to complete resection with stage I, II and III disease were analysed. The influence of residual disease (RD) in liver and lymph nodes on survival was assessed using the Kaplan-Meier curves. In addition, the rest of the group was assessed based on type of primary/secondary procedure, number of harvested lymph nodes and RD in liver and/or lymph nodes. Results In this retrospective study 48 out of 58 (83%) patients underwent re-resection. Among the group with a 5-year follow-up (re-operation between 2012–2014), 22 patients out of 28 (79%) were re-resected. Survival analysis showed that patients with no RD in the liver and lymph nodes had statistically significant better 5-year survival than those with RD. Comparing 5-year survival rate in patients with RD in the liver or lymph nodes against no RD group, patients with RD in the liver had statistically significantly worse 5-year survival, while lymph node metastases did not show any statistically significant different in 5-year survival. Besides, a statistically significant better prognosis was found in stage II disease compared to stage III, as expected. Conclusions The most important predictors of a 5-year survival in our study were RD in liver and stage of the disease. Lymph node metastases did not have any impact on the overall 5-year survival rate.

1849 LOCATION OF TUMOR IN THE BLADDER PREDICTS LIKELIHOOD OF LYMPH NODE METASTASES AT RADICAL CYSTECTOMY AND DISEASE RECURRENCE

2011 ◽  
Vol 185 (4S) ◽  
Author(s):  
Robert Svatek ◽  
Clark Wilson ◽  
Vipal Durkal ◽  
Stephen Culp ◽  
H. Barton Grossman ◽  
...  
Keyword(s):  
Lymph Node ◽  
Radical Cystectomy ◽  
Lymph Node Metastases ◽  
Disease Recurrence ◽  
Node Metastases

Prospective Study of Fluorodeoxyglucose–Positron Emission Tomography Imaging of Lymph Node Basins in Melanoma Patients Undergoing Sentinel Node Biopsy

1999 ◽  
Vol 17 (5) ◽  
pp. 1508-1508 ◽  
Author(s):  
Jeffrey D. Wagner ◽  
Donald Schauwecker ◽  
Darrell Davidson ◽  
John J. Coleman III ◽  
Scott Saxman ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Node ◽  
Lymph Node Metastases ◽  
Fdg Pet ◽  
Regional Lymph Node ◽  
Emission Tomography ◽  
Node Biopsy ◽  
Positron Emission ◽  
Node Metastases

PURPOSE: To prospectively compare positron emission tomography (PET) imaging of regional lymph node basins to sentinel node biopsy (SNB) in patients with American Joint Committee on Cancer (AJCC) stage I, II, and III melanoma localized to the skin. METHODS: Patients with cutaneous melanoma with Breslow's depth greater than 1 mm (AJCC T2-4N0M0) or localized regional cutaneous recurrence (TxN2bM0) underwent whole-body imaging of glucose metabolism with fluorodeoxyglucose (FDG) PET followed by SNB. PET scans were interpreted in a blinded fashion and compared with histologic analyses of SNB specimens and clinical follow-up examination. Nodal tumor volumes were estimated. RESULTS: Eighty-nine lymph node basins were evaluated by FDG-PET and SNB in 70 assessable patients. Eighteen patients (25.7%) had lymph node metastases at the time of FDG-PET imaging: 17 proved by SNB (24.3%) and one by follow-up examination (1.4%). Median tumor volume in positive sentinel node basins was 4.3 mm3 (range, 0.07 to 523 mm3). Sensitivity of SNB for detection of occult regional lymph node metastases was 94.4%, specificity was 100%, positive predictive value (PPV) was 100%, and negative predictive value (NPV) was 98.6%. Sensitivity of FDG-PET was 16.7%, specificity was 95.8%, PPV was 50%, and NPV was 81.9%. At a median follow-up duration of 16.6 months, seven patients (10%) developed recurrent disease. PET predicted one recurrence (14.3%) in a node basin missed by SNB. CONCLUSION: FDG-PET is an insensitive indicator of occult regional lymph node metastases in patients with melanoma because of the minute tumor volumes in this population. FDG-PET does not have a primary role for staging regional nodes in patients with clinically localized melanoma.

Sensitivity rate of ultrasound (US)-guided fine-needle aspiration cytology (FNAC) using the Berlin morphology criteria for lymph node metastases to reduce the need for surgical sentinel node (SN) staging in melanoma.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 8535-8535 ◽  
Author(s):  
Christiane A. Voit ◽  
Alexander Christopher Jonathan Van Akkooi ◽  
Saskia Gooskens ◽  
Petra Siegel ◽  
Gregor Schaefer-Hesterberg ◽  
...  
Keyword(s):  
Lymph Node ◽  
Clin Oncol ◽  
Lymph Node Metastases ◽  
High Sensitivity ◽  
Needle Aspiration ◽  
Tumor Burden ◽  
Maximum Diameter ◽  
Node Metastases ◽  
Rotterdam Criteria

8535 Background: US-guided-FNAC prior to surgical SN staging is emerging as a possible cost-effective addition to the staging of melanoma patients (pts). Formerly, sensitivity (sens) rates of lymph node US in melanoma were disappointing (20–40%). The introduction of the Berlin Morphology Criteria has significantly improved sens rates for US-FNAC (J Clin Oncol 2010;28(5):847-52). The aim of the current study was to report on 1000 patients the sens, specificity (spec), positive (PPV) and negative (NPV) predictive value rates of US-FNAC from our prospective database with prolonged follow-up. Methods: Since 2001, >1000 stage I / II consecutive melanoma pts have undergone US-FNAC prior to SN. All patients underwent lymphoscintigraphy. Peripheral Perfusion (PP), Loss of Central Echoes (LCE), Balloon Shaped (BS) were the Berlin Morphology Criteria which were registered. FNAC was performed in case of presence of any of these factors. SN tumor burden was measured according to the Rotterdam Criteria. All patients underwent SN or LND in case of positive FNAC. Results: Mean/median Breslow thickness was 2.56 / 1.57 mm (0.2 – 44 mm).Mean/median follow-up was 39 / 32 months (0 – 115). Ulceration was present in 24 %. SN positivity rates were 20 % (202 / 1000). Sens was 51 %. Spec, PPV and NPV were 99%, 91% and 89%. Sensitivity was highest for T4 tumors (77%). PP, LCE, BS had sens of 69%, 24%, 25%. SN tumor burden > 1 mm in largest diameter according to the Rotterdam Criteria was identified by US-FNAC in 86%. Threshold for positive FNAC was 0.4 mm in maximum diameter. Conclusions: The new criterion of Periferal Perfusion is of key importance to achieve the high sensitivity of US-FNAC according to the Berlin Morphology Criteria (J Clin Oncol 2010; 28:847-852) to identify lymph node metastases. Especially for T4 patients and in patients with advanced SN tumor burden it can reduce significantly the need for surgical SN staging. The EORTC Melanoma Group will launch the prospective validation study, USE FNAC, in 2012.

Incidence, significance, and follow-up of para-aortic lymph node metastases in late invasive carcinoma of the cervix

1977 ◽  
Vol 128 (3) ◽  
pp. 336-340 ◽  
Author(s):  
James H. Nelson ◽  
John Boyce ◽  
Milagros Macasaet ◽  
Therese Lu ◽  
Joseph F. Bohorquez ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastases ◽  
Invasive Carcinoma ◽  
Aortic Lymph Node ◽  
Node Metastases

scholarly journals Malignant Paragangliomas Associated with Mutations in the Succinate Dehydrogenase D Gene

2007 ◽  
Vol 92 (4) ◽  
pp. 1245-1248 ◽  
Author(s):  
B. Havekes ◽  
E. P. M. Corssmit ◽  
J. C. Jansen ◽  
A. G. L. van der Mey ◽  
A. H. J. T. Vriends ◽  
...  
Keyword(s):  
Lymph Node ◽  
Succinate Dehydrogenase ◽  
Lymph Node Metastases ◽  
Expression Patterns ◽  
Interindividual Variations ◽  
Subclinical Disease ◽  
Catecholamine Excess ◽  
Node Metastases ◽  
Head And Neck Paraganglioma

Abstract Introduction: Malignant paragangliomas have been well described in carriers of mutations of the succinate dehydrogenase B (SDHB) gene, but have rarely been associated with mutations in the succinate dehydrogenase D (SDHD) gene. Aim: The aim of the study was to report the different clinical expression patterns of malignant paragangliomas in five patients with SDHD (D92Y) mutations observed in approximately 200 SDHD (D92Y) mutation carriers followed in our institution. Results: Metastasis and/or local tumor invasion was documented 0 (n = 2), 1, 18, and 30 yr after the initial diagnosis of paraganglioma. Malignancy was proven by paraganglioma bone metastases (n = 2), intrathoracic paraganglioma with lymph node metastases, locally invasive head-and-neck paraganglioma with destruction of the petrosal bone, and locally invasive paraganglioma of the bladder with lymph node metastases. Four of the five patients developed catecholamine excess during follow-up due to intraadrenal paraganglioma (pheochromocytoma) (n = 1), extra adrenal paraganglioma (n = 2), and presumed subclinical disease (n = 1). Conclusion: SDHD mutations (D92Y) are associated with malignant paragangliomas and catecholamine excess with remarkable interindividual variations despite the same mutation. We estimate that the prevalence of malignancy in carriers of D92Y mutations is at least 2.5%.

The risk of nodal metastasis in early adenocarcinoma of the uterine cervix*

2004 ◽  
Vol 14 (1) ◽  
pp. 104-109 ◽  
Author(s):  
J. Balega ◽  
H. Michael ◽  
J. Hurteau ◽  
D. H. Moore ◽  
J. Santiesteban ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastases ◽  
Medical Center ◽  
Conservative Surgery ◽  
Disease Recurrence ◽  
Nodal Metastasis ◽  
Pelvic Lymphadenectomy ◽  
Depth Of Invasion ◽  
Nodal Metastases ◽  
Node Metastases

A functional and widely accepted definition of microinvasive cervical adenocarcinoma remains elusive. The purpose of this study was to determine at which depth of invasion the likelihood of lymph node metastasis or disease recurrence was so small that conservative surgery could be considered appropriate. Charts of patients with adenocarcinoma of the cervix (ACC) who underwent radical hysterectomy and pelvic lymphadenectomy (n = 98) at Indiana University Medical Center from 1987 to 1998 were retrospectively reviewed. Patients with stage IA1–IB1 lesions were included in the study. Patients treated with preoperative radiotherapy were excluded. Pathologic parameters evaluated included histologic type, depth of stromal invasion (DOI), and the presence of lymphatic vascular space invasion, or lymph node metastases. The patient median age was 39 years (20–65). The median time of follow-up was 30 months (4–124). Lymph node metastases were found in ten patients and 11 developed recurrences. The precise DOI could be measured in 84 patients. Of the 48 patients with cancers with a DOI ≤ 5 mm, none had involved parametria or nodes; whereas eight of the 36 with a DOI > 5 mm had nodal metastases (P = 0.00069). None of these 48 patients with a tumor DOI ≤ 5 mm developed a recurrence whereas six of the 36 patients with a tumor DOI > 5 mm developed recurrent disease (P = 0.0048). The risk of nodal metastases and recurrence is so low in patients with ACC and DOI ≤ 5 mm that for patients with such depth documented on conization with negative margins pelvic lymphadenectomy may be omitted.

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