scholarly journals Safety and feasibility of total laparoscopic radical resection of Siewert type II gastroesophageal junction adenocarcinoma through the left diaphragm and left thoracic auxiliary hole

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yun Huang ◽  
Gang Liu ◽  
Xiumei Wang ◽  
Yan Zhang ◽  
Guijun Zou ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Prospective Study ◽  
Gastroesophageal Junction ◽  
Safety Margin ◽  
Radical Resection ◽  
Esophageal Hiatus ◽  
Left Chest ◽  
Left Diaphragm ◽  
Surgical Data

Abstract Background The incidence of adenocarcinoma of the esophagogastric junction (AEG) is rising every year; however, the mode of operation for Siewert II AEG is still controversial. Accumulating evidence has shown that transabdominal surgery is better than transthoracic surgery for Siewert II AEG with esophageal invasion < 3 cm. In patients with obesity, a large tumor size, and high transection of the esophagus, the transabdominal esophageal hiatus approach for lower mediastinal lymph node dissection and posterior mediastinal anastomosis is difficult. Thus, total laparoscopic radical resection of Siewert II AEG is carried out through the left diaphragm and left chest auxiliary hole for the optimal surgical field of vision and space. In this prospective study, we assessed the feasibility of carrying out the procedure abdominally through the left diaphragm and auxiliary hole. Methods Ten patients with Siewert II AEG were recruited between April and June 2019. Siewert II AEG was treated by total laparoscopy through the left diaphragm and left chest auxiliary hole. Clinicopathological features, surgical data, and adverse events were collected and analyzed in this prospective study. Results The average duration of the operation was 348 ± 37.52 min, lower mediastinal dissection took 20.6 min, the OrVil anastomosis time was 29.8 min, the time necessary to suture the seromuscular layer through the left thoracic auxiliary hole was 11 min, the safety margin was 3.2 cm, and the total number of lymph nodes dissected was 40.6. The number of lower mediastinal lymph nodes dissected was 6.2. The rate of lymph node metastasis in the N110 group was 9 ± 12.45%, and the average intraoperative blood loss was 170 ± 57.47 mL. No anastomotic leakage or anastomotic stricture occurred after the operation. The time of intestinal function recovery was 2 days, and the first time of enteral nutrition through a jejunal nutrition tube was 2.4 days. No tumor recurrence was found in 10 patients at 1 year postoperatively. Conclusion Total laparoscopic radical resection through the left diaphragm and left thoracic auxiliary hole for Siewert II AEG patients is feasible and safe. Thus, it may be a good surgical alternative for patients with esophageal tumors invading less than 3 cm. Trial registration ChiCTR, ChiCTR2000034286. Registered 8 July 2020, http://www.chictr.org.cn/showproj.aspx?proj=55866.

scholarly journals Genomic Heterogeneity and Clonal Evolution in Gastroesophageal Junction Cancer Revealed by Single Cell DNA Sequencing

2021 ◽  
Vol 11 ◽  
Author(s):  
Qingke Duan ◽  
Chao Tang ◽  
Zhao Ma ◽  
Chuangui Chen ◽  
Xiaobin Shang ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Dna Sequencing ◽  
Single Cell ◽  
Single Cells ◽  
Clonal Evolution ◽  
Gastroesophageal Junction ◽  
Common Mutation ◽  
Node Metastasis

Gastroesophageal junction (GEJ) cancer is a tumor that occurs at the junction of stomach and esophagus anatomically. GEJ cancer frequently metastasizes to lymph nodes, however the heterogeneity and clonal evolution process are unclear. This study is the first of this kind to use single cell DNA sequencing to determine genomic variations and clonal evolution related to lymph node metastasis. Multiple Annealing and Looping Based Amplification Cycles (MALBAC) and bulk exome sequencing were performed to detect single cell copy number variations (CNVs) and single nucleotide variations (SNVs) respectively. Four GEJ cancer patients were enrolled with two (Pt.3, Pt.4) having metastatic lymph nodes. The most common mutation we found happened in the TTN gene, which was reported to be related with the tumor mutation burden in cancers. Significant intra-patient heterogeneity in SNVs and CNVs were found. We identified the SNV subclonal architecture in each tumor. To study the heterogeneity of CNVs, the single cells were sequenced. The number of subclones in the primary tumor was larger than that in lymph nodes, indicating the heterogeneity of primary site was higher. We observed two patterns of multi-station lymph node metastasis: one was skip metastasis and the other was to follow the lymphatic drainage. Taken together, our single cell genomic analysis has revealed the heterogeneity and clonal evolution in GEJ cancer.

P219 THE ROLE OF PET-CT IN THE EVALUATION OF LYMPH NODE INVOLVEMENT IN ESOPHAGEAL AND GASTROESOPHAGEAL JUNCTION CARCINOMA - A 5-YEAR SINGLE CENTER EXPERIENCE

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Chrysovalantis Vergadis ◽  
Eustratia Mpaili ◽  
Athanasios Syllaios ◽  
Maria Mpoura ◽  
Adamantios Michalinos ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
False Positive ◽  
Gastroesophageal Junction ◽  
Preoperative Staging ◽  
False Negative ◽  
Clinical Staging ◽  
Lymph Node Status ◽  
Pathology Report ◽  
Pet Ct

Abstract Aim To determine the efficacy of positron emission tomography-computed tomography (PET-CT) in the evaluation of lymph node status during preoperative staging on patients with esophageal and gastrοesophageal junction carcinoma compared to the final histopathological findings. Background & Methods Data on patients that underwent esophagectomy from 01/03/2014 to 01/03/2019 were prospectively collected and retrospectively reviewed. Based on the medical records, the following parameters were extracted and analyzed: patient demographics, histopathological parameters, surgical and oncological outcomes. All patients were staged according to the AJCC 8th edition. Results A total of 79 patients underwent Ivor Lewis or McKeown esophagectomy for either squamous cell carcinoma (n= 7 patients) or adenocarcinoma of esophagus or gastroesophageal junction (n= 72 patients). In 60 cases, clinical staging was conducted without performing PET- CT, while 19 cases underwent PET-CT. Among the 19 patients, 16 (84.2%) were men, and 3 (15.8 %) were women. Mean age was 62 years, (range 41- 72). Mean nodal harvest per patient was 30.6 lymph nodes. Twelve out of 19 patients (63.2%) revealed lymph node invasion, with a mean of 5.6 positive lymph nodes per patient. PET-CT identified the primary tumor in all 19 patients (100%). PET-CT demonstrated 100% compliance with the final histopathological reports regarding N status in only 5 out of 19 cases (26.3%). Four patients were staged as N0 both pre- and postoperatively, while one was deemed positive by PET-CT in right paracardial lymph nodes which was histopathologically confirmed. In other 4 patients (21.1%), PET-CT was 100% false negative, whereas in 3 patients (15.8%) PET-CT was 100% false positive. In the remaining 7 patients, PET-CT findings were in accordance with the pathology report in 7 out of 25 examined lymph node stations, false positive in 9 out of 25 and false negative in 9 out of 25. Conclusion PET-CT seems to have a considerable number of false positive and false negative results in esophageal cancer in our study as far as N-staging is concerned. Further studies with larger sample size are needed to reach more conclusive results.

scholarly journals Frequency of metastasis to posterior triangle and lower deep jugular lymph nodes in patients with squamous cell carcinoma of oral cavity having clinically N1 neck

2019 ◽  
Vol 5 (5) ◽  
pp. 1286
Author(s):  
Shilpa Varchasvi ◽  
Azeem Moyihuddin
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Oral Cavity ◽  
Lymph Nodes ◽  
Prospective Study ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Buccal Mucosa ◽  
Research Centre ◽  
Posterior Triangle

<p class="abstract"><strong>Background:</strong> Oral cancer is the sixth most common cancer in the world and is largely preventable. The objective of the study is to find out the frequency of metastasis to posterior triangle lymph nodes and lower deep jugular (supraclavicular) lymph nodes in patients with squamous cell carcinoma of oral cavity having clinically N<sub>1 </sub>neck.</p><p class="abstract"><strong>Methods:</strong> A hospital based prospective study.<strong> </strong>This prospective study was conducted in R. L. Jalappa Hospital and Research Centre and SDU Medical College Kolar, Karnataka. 30 patients having oral squamous cell carcinoma with clinically N<sub>1 </sub>neck (single ipsilateral lymph node less than 3cms in diameter) undergoing modified radical neck dissection in R. L. Jalappa Hospital and Research Centre.  </p><p class="abstract"><strong>Results:</strong> In our study, 4 were male (13%) and 26 were females (87%). The age of the patients ranged from 41-70 years with a mean age of 53 years.<strong> </strong>Majority of primary tumours were buccal mucosa tumours (24). We had 6 anterior 2/3<sup>rd</sup> tongue tumours. The primary tumour staging included 17 T<sub>2 </sub>lesions (57%), 3 T<sub>3 </sub>lesions (10%), 10 T<sub>4 </sub>lesions (33%) in patients with buccal mucosa carcinoma, fourteen patients had T<sub>2 </sub>disease, 9 patients had T<sub>4</sub> and one patient had T<sub>3</sub> disease.</p><p class="abstract"><strong>Conclusions:</strong> Most common nodal involvement in buccal mucosa carcinoma was level Ib (submandibular lymph node). The incidence of level IV (supraclavicular) and level V (posterior triangle) lymph node metastasis is low in buccal mucosa carcinoma patients with clinically N<sub>1</sub> neck.</p>

Risk Factors for Metastasis to No.253 Lymph Node for Colorectal Cancer Patients

2020 ◽  
Author(s):  
Zhouyuan Du ◽  
Dianshi Wang ◽  
Yuan Li ◽  
Peng Hu ◽  
Chuanqing Wu ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymphovascular Invasion ◽  
Perineural Invasion ◽  
Radical Resection ◽  
Histologic Grade ◽  
Tumor Type ◽  
Lymph Nodes Metastasis

Abstract Background: No.253 lymph nodes metastasis is related to poor prognosis of colorectal cancer, while the role of No.253 lymph nodes dissection in colorectal cancer is still controversial.Methods: A total of 157 patients who were received laparoscopic radical resection of colorectal cancer with preservation of the left colon artery + D3 lymph node dissection (low ligation + high dissection) in our hospital were enrolled. No.253 lymph nodes of each patients were dissected and sent for examination. Clinicaopathological factors correlated with No.253 lymph nodes metastasis, including gender, age, tumor location, tumor size, length of tumor from the anus, whether lymphovascular invasion, whether perineural invasion, tumor markers CEA, CA125 and CA199, tumor T stage, whether it is distant metastasis, the total number of lymph nodes harvested, tumor type, and histologic grade were respectively analyzed.Results: A total of 2286 lymph nodes were sent for examination, of which 557 No.253 lymph nodes were sent for examination. Among them, 5 patients had a total of 27 No.253 lymph node metastases. Preoperative CA125 level (X2=4.736, p=0.030), whether perineural invasion (X2=8.086, p<0.01), whether lymphovascular invasion (X2= 7.053, p<0.01), tumor type (X2=21.019, p<0.01), histologic grade (X2=15.315, p<0.01) were significantly correlated with positive No.253 lymph nodes metastasis. A multivariate logistic regression analysis showed that none of risk factor from above are independent risk factors for No.253 lymph node metastasis(P>0.05).Conclusion: Preoperative CA125 level, whether perineural invasion, whether lymphovascular invasion, tumor type, histologic grade were risk factors of the No.253 lymph nodes metastasis. Multivariate analysis showed that five risk factors from above were not the independent risk factor for No.253 lymph nodes metastasis. Colorectal cancer patients with the risk factors above were suggested to receive radical resection + D3 lymph node dissection.

P221 THE ROLE OF SUBCARINAL LYMPH NODE DISSECTION IN ESOPHAGECTOMY - A 5-YEAR SINGLE CENTER EXPERIENCE

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Eustratia Mpaili ◽  
Dimitrios Schizas ◽  
Maria Mpoura ◽  
Ilias Vagios ◽  
Constantinos Zografos ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Squamous Cell ◽  
Cell Cancer ◽  
Gastroesophageal Junction ◽  
Neoadjuvant Treatment ◽  
Node Dissection ◽  
Subcarinal Lymph Node

Abstract Aim To evaluate the involvement of subcarinal lymph node dissection (SLND) in the surgical treatment of esophageal cancer, as well as its impact on surgical outcomes following esophagectomy. Background & Methods Data on patients that underwent esophagectomy from 01/03/2014 to 01/03/2019 were prospectively collected and retrospectively reviewed. Based on the medical records, the following parameters were collected and analyzed: patient demographics, histopathological parameters, surgical- oncological outcomes. All patients were staged according to the AJCC 8th edition. Results A total of 79 patients underwent Ivor Lewis or McKeown esophagectomy for either squamous cell carcinoma (n= 7 patients) or adenocarcinoma of the esophagus or gastroesophageal junction (n= 72 patients). In 26 cases, esophagectomy was performed without SLND, while 53 cases underwent SLND. Among the 53 patients, 50 (94.3%) were men, and 3 (5.7 %) were women. Mean age was 61.4 years, (range 34-78). Mean nodal harvest was 34.7 lymph nodes per patient. Lymph node invasion was noted in 33 patients (62.2%), with a mean of 9 positive lymph nodes per patient. Subcarinal lymph nodes were involved in 5 out of 53 patients (9.4%). The ratio of positive subcarinal lymph nodes to resected ones was 1/2 (50%), 3/3 (100%), 1/2 (50%), 1/2 (50%) and 1/1 (100%) for each patient. Final histopathological report showed adenocarcinoma of moderate or poor differentiation (G2 2/5, G3 3/5) in all five patients (100%). Four out of 5 patients had not received neoadjuvant treatment and their pathological staging was T3N3M0. One patient had received neoadjuvant chemotherapy and his final staging was ypT3N2M0. Noteworthy, the seven patients diagnosed with squamous carcinoma, were subjected to SLND and were 100% negative for invasion histologically. Conclusion Subcarinal lymph nodes were infiltrated in 9.4% of patients operated for esophageal cancer. In the squamous cell cancer group, the relative infiltration rate was notably 0%. It seems that omission of subcarinal lymph node dissection during transthoracic esophagectomy cannot be justified.

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