S2493 The Curious Case of the Aortopulmonary Window Lymph Node

Abstract Background Lymph node dissection (LND) is part of standard operating procedure in resectable esophageal cancer patients regardless of lymph node status. The aim of this case vignette survey was to acquire expert opinions on current practice of LND, and to determine potential consequences of non-invasive lymph node staging on the extent of LND and postoperative morbidity. Methods An online survey including 5 short clinical cases (case vignettes) was sent to 272 esophageal surgeons worldwide. Extent of standard LND, potential changes in LND based on accurate lymph node staging and consequences for postoperative morbidity were evaluated. Results 86 esophageal surgeons (median experience in esophageal surgery of 15 years) participated in the survey (response rate 32%). Standard LND varied considerably between experts, for example pulmonary ligament, splenic artery, aortopulmonary window and paratracheal lymph nodes are routinely dissected in less than 60%. The omission of (parts of) LND is expected to decrease the number of chyle leakages, pneumonias laryngeal nerve pareses and reduce operating time. In order to guide surgical treatment decisions, a diagnostic test for lymph node staging after neoadjuvant therapy requires a minimum sensitivity of 92% and specificity of 90%. Conclusion This expert case vignette survey study shows that there is no consensus on the extent of standard LND. Esophageal surgeons seem more willing to extend LND rather than omit LND, based on accurate lymph node staging. The majority of surgeons expect that less extensive LND can reduce post-operative morbidity.

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Extent and consequences of lymphadenectomy in oesophageal cancer surgery: case vignette survey

BMJ Surgery, Interventions, & Health Technologies ◽

10.1136/bmjsit-2019-000026 ◽

2020 ◽

Vol 2 (1) ◽

pp. e000026 ◽

Cited By ~ 1

Author(s):

Didi JJM de Gouw ◽

Mirre Scholte ◽

Suzanne S Gisbertz ◽

Bas P L Wijnhoven ◽

Maroeska M Rovers ◽

...

Keyword(s):

Lymph Node ◽

Oesophageal Cancer ◽

Online Survey ◽

Postoperative Morbidity ◽

Operating Time ◽

Neoadjuvant Chemoradiotherapy ◽

Standard Operating Procedure ◽

Survey Study ◽

Case Vignette ◽

Aortopulmonary Window

ObjectivesLymph node dissection (LND) is part of the standard operating procedure in patients with resectable oesophageal cancer after neoadjuvant chemoradiotherapy regardless of lymph node (LN) status. The aims of this case vignette survey were to acquire expert opinions on the current practice of LND and to determine potential consequences of non-invasive LN staging on the extent of LND and postoperative morbidity.DesignAn online survey including five short clinical cases (case vignettes) was sent to 272 oesophageal surgeons worldwide.Participants86 oesophageal surgeons (median experience in oesophageal surgery of 15 years) participated in the survey (response rate 32%).Main outcome measuresExtent of standard LND, potential changes in LND based on accurate LN staging and consequences for postoperative morbidity were evaluated.ResultsStandard LND varied considerably between experts; for example, pulmonary ligament, splenic artery, aortopulmonary window and paratracheal LNs are routinely dissected in less than 60%. The omission of (parts of) LND is expected to decrease the number of chyle leakages, pneumonias, and laryngeal nerve pareses and to reduce operating time. In order to guide surgical treatment decisions, a diagnostic test for LN staging after neoadjuvant therapy requires a minimum sensitivity of 92% and a specificity of 90%.ConclusionsThis expert case vignette survey study shows that there is no consensus on the extent of standard LND. Oesophageal surgeons seem more willing to extend LND rather than omit LND, based on accurate LN staging. The majority of surgeons expect that less extensive LND can reduce postoperative morbidity.

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Aortopulmonary Window Lymph Node

10.32388/s9it93 ◽

2020 ◽

Author(s):

Keyword(s):

Lymph Node ◽

Aortopulmonary Window

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Scanning electron microscopy of freeze-fractured prescapular lymph node of caprine

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100111331 ◽

1984 ◽

Vol 42 ◽

pp. 244-245

Author(s):

O. Faroon ◽

F. Al-Bagdadi ◽

T. G. Snider ◽

C. Titkemeyer

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Lymphatic System ◽

Three Dimensional ◽

Meat Products ◽

The Body ◽

Morphological Data ◽

The World ◽

Cellular Constituent ◽

Scanning Electron

The lymphatic system is very important in the immunological activities of the body. Clinicians confirm the diagnosis of infectious diseases by palpating the involved cutaneous lymph node for changes in size, heat, and consistency. Clinical pathologists diagnose systemic diseases through biopsies of superficial lymph nodes. In many parts of the world the goat is considered as an important source of milk and meat products.The lymphatic system has been studied extensively. These studies lack precise information on the natural morphology of the lymph nodes and their vascular and cellular constituent. This is due to using improper technique for such studies. A few studies used the SEM, conducted by cutting the lymph node with a blade. The morphological data collected by this method are artificial and do not reflect the normal three dimensional surface of the examined area of the lymph node. SEM has been used to study the lymph vessels and lymph nodes of different animals. No information on the cutaneous lymph nodes of the goat has ever been collected using the scanning electron microscope.

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