scholarly journals Factors associated with postoperative hypocalcemia following surgery for thyroid cancer in childhood

2021 ◽  
Author(s):  
Claudio Spinelli ◽  
Marco Ghionzoli ◽  
Alessia Bertocchini ◽  
Beatrice Sanna ◽  
Carlotta Plessi ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Thyroid Surgery ◽  
Tumor Size ◽  
Pediatric Population ◽  
Follicular Carcinoma ◽  
Node Dissection ◽  
Sample Collection ◽  
Postoperative Hypocalcemia ◽  
Factors Associated

Background: Postoperative hypocalcemia is a frequent complication after thyroid surgery. Hypoparathyroidism may develop as transient (TtHP), with normalization within six months from surgery, or permanent (PtHP) if the patient requires replacement therapy. The present study analyzes rates and factors associated with the development of TtHP or PtHP following thyroid surgery in a pediatric population. Procedure: A retrospective multicenter study analyzing 363 patients was carried out. We recorded gender, age, tumor size, type of surgery, lymph node dissection, histology. Calcium levels were acquired daily for 72 hours after discharge. Subsequent sample collection was customized on the patient’s hypocalcemia severity. Results: We analyzed 363 patients aged ≤18 years (mean age 14.2 years) who underwent thyroid surgery clustered into age groups (≤15 or >15). Patients mean follow-up was 5.8 years (1-11yrs). At histology 310 (85%) were papillary carcinoma, 32 (9%) were follicular carcinoma, 6 (2%) presented diffuse sclerosing variant of papillary thyroid carcinoma whilst 15 (4%) had familial medullary carcinoma. TtHP developed in 36 (9,9%), PtHP in 20 (5.5%) cases. TtHP was more frequent in younger patients (p=0,009). Both PtHP and TtHP were increased in case of larger tumors (≥2 cm) (p=0,001). All TtHP and PtHP were in TT group. PtHP rate was increased if lymph node dissection was carried out (p<0.001). Conclusions: The risk of hypoparathyroidism is related to younger age, tumor size, TT and lymph node dissection therefore surgeons should tailor surgery as much as possible to avert such complication.

Risk factors associated with lymphedema after lymph node dissection in melanoma patients

2015 ◽  
Vol 210 (6) ◽  
pp. 1178-1184 ◽  
Author(s):  
Jeffrey F. Friedman ◽  
Bipin Sunkara ◽  
Jennifer S. Jehnsen ◽  
Allison Durham ◽  
Timothy Johnson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymph Node ◽  
Lymph Node Dissection ◽  
Node Dissection ◽  
Factors Associated ◽  
Melanoma Patients

An Evaluation of Frozen Section and Lymph Node Dissection Results for Mucinous Ovarian Tumors

2018 ◽  
Vol 28 (1) ◽  
pp. 92-98 ◽  
Author(s):  
Marisa R. Moroney ◽  
Miriam D. Post ◽  
Amber A. Berning ◽  
Jeanelle Sheeder ◽  
Bradley R. Corr
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Tumor Size ◽  
Frozen Section ◽  
Ovarian Tumors ◽  
Node Dissection ◽  
Cross Sectional ◽  
Mucinous Histology ◽  
Final Pathology ◽  
Mucinous Ovarian Tumors

ObjectivesIntraoperative frozen section has greater than 90% accuracy for ovarian tumors; however, mucinous histology has been shown to be associated with increased frozen section inaccuracy. Recent data demonstrate that primary ovarian mucinous carcinomas have no lymph node involvement, even when extraovarian disease is present, and therefore may not require lymph node dissection. Our primary objective is to evaluate the accuracy of identifying mucinous histology on frozen section.Methods/MaterialsA cross-sectional review of mucinous ovarian tumors in surgical patients at one institution from 2006 to 2016 was performed. Cases reporting a mucinous ovarian tumor on frozen section or final pathology were identified. Frozen section results were compared with final diagnosis to calculate concordance rates. Analyses with χ2 and t tests were performed to identify variables associated with pathology discordance.ResultsA total of 126 mucinous ovarian tumors were identified. Of these, 106 were reported as mucinous on frozen section and 103 (97.2%) were concordant on final pathology. Discordant cases included 2 serous and 1 clear cell tumor. Among the 103 mucinous tumors, classification as malignant, borderline, or benign was concordant in 74 (71.8%) of 103 cases, whereas 22 (21.4%) of 103 were discordant and 7 (6.8%) were deferred to final pathology. Lymph node dissection was performed in 33 cases; the only case with lymph node metastasis was a gastrointestinal mucinous adenocarcinoma. Discordance between frozen section and final pathology was associated with larger tumor size and diagnosis other than benign: discordant cases had a mean tumor size of 21.7 cm compared with 14.4 cm for concordant cases (P < 0.001), and 93.5% of discordant cases were borderline or malignant, compared with 30.5% of concordant cases (P < 0.001).ConclusionsIntraoperative identification of mucinous histology by frozen section is reliable with a concordance rate to final pathology of 97.2%. No lymph node metastases were present in any malignant or borderline primary ovarian cases.

scholarly journals [Table 5.5.a.1] Tumor size and treatment (rate of resectability) [Figure 5.5.a.2] Cumulative survival of the patients after pancreatectomy for TS1 cancer according to residual tumors [Figure 5.5.a.3] Cumulative survival of the patients with TS1 cancer according to extent of lymph node dissection [Figure 5.5.a.4] Combined resection of portal vein and cumulative survival of the patients after pancreatectomy for TS1 cancer of UICC Stage IIa or IIb in the pancreatic head [Figure 5.5.a.5] Combined resection of peripancreatic plexus and cumulative survival of the patients after pancreatectomy for TS1 cancer of UICC Stage IIa or IIb in the pancreatic head [Figure 5.5.a.6] Combined resection of peripancreatic plexus when there is no plexus infiltration and cumulative survival of the patients after pancreatectomy for TS1 cancer of UICC Stage IIa or IIb in the pancreatic head [Figure 5.5.a.7] Combined resection of artery and cumulative survival of the patients after pancreatectomy for TS1 cancer of UICC Stage IIa or IIb in the pancreatic head [Figure 5.5.a.8] Combined resection of portal vein and cumulative survival of the patients after pancreatectomy for TS2 (2.1-4.0 cm) cancer of UICC Stage IIa or IIb in the pancreatic head [Figure 5.5.a.9] Combined resection of peripancreatic plexus and cumulative survival of the patients after pancreatectomy for TS2 (2.1-4.0 cm) cancer of UICC Stage IIa or IIb in the pancreatic head

Suizo ◽  
2007 ◽  
Vol 22 (1) ◽  
pp. e239-e247
Keyword(s):  
Lymph Node ◽  
Portal Vein ◽  
Lymph Node Dissection ◽  
Tumor Size ◽  
Pancreatic Head ◽  
Uicc Stage ◽  
Node Dissection ◽  
Treatment Rate ◽  
Cumulative Survival ◽  
Combined Resection

Outcome analysis for melanoma patients undergoing deep pelvic lymph node dissection

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 8514-8514
Author(s):  
B. Badgwell ◽  
Y. Xing ◽  
J. Gershenwald ◽  
J. Lee ◽  
P. Mansfield ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Metastatic Disease ◽  
Pelvic Lymph Node Dissection ◽  
Pelvic Lymph Node ◽  
Survival Outcomes ◽  
Node Dissection ◽  
Factors Associated ◽  
Melanoma Patients

8514 Background: The benefits of deep pelvic lymph node dissection (DLND) for node-positive melanoma patients continue to be debated. The objective of our analysis was to assess factors associated with metastatic disease to deep pelvic nodes and examine survival outcomes following DLND. Methods: We retrospectively reviewed the records of 804 patients undergoing lymph node dissection (1990-2001). 97 patients underwent a superficial inguinofemoral lymph node dissection along with a DLND for indications which included: suspicious radiologic imaging (n= 31), documented superficial disease and concern for deep involvement (n = 57), and in-transit disease undergoing limb perfusion (n=9). Logistic regression was performed to identify factors associated with the metastatic tumor spread to deep nodes. Associations between clinicopathologic factors and disease-specific survival (DSS) were estimated using the Cox proportional hazards model. Results: Fifty-four patients (56%) had metastatic disease (median 2 positive lymph nodes, range 1–12) within their deep pelvis. With a median follow-up of 7.5 years, the 5-year DSS was 42% for patients with positive deep pelvic nodes and 52% for those with negative deep pelvic nodes (p = 0.07). When the number of metastatic deep nodes was stratified, the 5-year DSS for patients with 1 positive node, 2–3 positive nodes, and >3 positive nodes was 49%, 48%, and 27%, respectively (p = 0.04). Age ≥ 50 years (odds ratio [OR] = 3.5, p = 0.03), increasing number of positive superficial nodes (OR = 2.1, p < 0.001), and suspicious findings on pelvic CT images (OR = 11.9, p < 0.001) were associated with metastatic deep nodes. In the multivariate analysis, the number of positive deep nodes (hazard ratio [HR] = 1.1, p = 0.03), male gender (HR = 1.9, p = 0.03), and extra-capsular nodal extension of tumor (HR = 2.7, p < 0.001) were identified as adverse prognostic factors for DSS. Conclusions: Survival outcomes in patients with melanoma metastatic to ≤ 3 deep pelvic lymph nodes are comparable to those in patients without deep nodal involvement. These favorable outcomes support an aggressive surgical approach (i.e., DLND) in patients ≥ 50 years, with multiple positive superficial nodes, and suspicious CT findings. No significant financial relationships to disclose.

Clinico-epidemiologic characteristics and patterns of care in Merkel cell carcinoma: Data from a single-institution series.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21049-e21049
Author(s):  
Michael Del Rosario ◽  
Eric Anderson ◽  
Yani Lu ◽  
Stephanie Farrell ◽  
Steven C. Plaxe ◽  
...  
Keyword(s):  
Lymph Node ◽  
Statistical Analysis ◽  
Cell Carcinoma ◽  
Lymph Node Dissection ◽  
Merkel Cell Carcinoma ◽  
Tumor Size ◽  
Primary Tumor ◽  
Merkel Cell ◽  
Node Dissection ◽  
Primary Tumor Size

e21049 Background: Merkel cell carcinoma (MCC) is associated with increased sun exposure. There is an average of 348 days of sunshine per year in our geographic area. Methods: With the IRB approval, we performed a retrospective chart review of all consecutive MCC patients seen at our institution between 2006-2017. Clinico-epidemiologic data such as age, gender, race, stage, tumor size, stage at presentation, and disease course were collected. Therapy and survival were analyzed. Using the surveillance, epidemiology, and end results program (SEER), we identified 4,256 patients with MCC from the years 2006-2013. We compared our data with the SEER findings . Statistical analysis: Chi-square and Fishers’ exact tests were used to assess the significance of associations in large and small populations, respectively. Survival analyses were performed using the Cox proportional hazards. Results: We identified 40 patients with MCC (n = 40) with a median age of 77. Compared to SEER data, our population was entirely Caucasian (100% vs. 95%; p = 0.11) and male predominant (75% vs. 63%; p = 0.11). The patients in our cohort were diagnosed more often with TNM stage I (50% vs. 39%; p = 0.00003) and found to have more often a primary tumor size < 2cm (58% vs. 34%; p < 0.01). Our patients were more frequently treated with lymph node dissection (70% vs. 63%, p = 0.002) and radiation therapy (60% vs. 50%; p = 0.24). Conclusions: Compared to the general population, MCC patients treated at our institution had similar mean age at diagnosis, gender and racial distribution and radiation treatment frequency (all p-values > 0.05). However, our patient population was significantly more likely to be diagnosed at stage I disease, have a primary tumor size less than 2 cm and receive lymph node dissection. Final statistical analysis, including survival analysis, and significance are to be discussed.

Factors Predictive of Tumor-Positive Nonsentinel Lymph Nodes After Tumor-Positive Sentinel Lymph Node Dissection for Melanoma

2004 ◽  
Vol 22 (18) ◽  
pp. 3677-3684 ◽  
Author(s):  
Jonathan H. Lee ◽  
Richard Essner ◽  
Hitoe Torisu-Itakura ◽  
Leslie Wanek ◽  
Hejing Wang ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Tumor Size ◽  
Risk Group ◽  
Wald Test ◽  
Positive Sentinel Lymph Node ◽  
High Risk Group ◽  
Node Dissection ◽  
Nodal Disease ◽  
Univariate Analyses

Purpose Approximately 20% of sentinel node (SN) positive melanoma patients have additional non-SN (NSN) metastasis. The rationale for this study was to identify the factors associated with additional nodal disease, as a method to determine which patients may most benefit from completion lymph node dissection (CLND). Patients and Methods During 1990 to 2002, 1,599 patients have undergone SN biopsy at our institute. 19.5% underwent CLND for tumor-positive SN. One hundred ninety-one of these patients had clinicopathologic information available for review. Univariate analyses used χ2 test, Wilcoxson rank sum test, and χ2 test for trend. Multivariate analyses used logistic regression and Wald test. Results Forty-six (24%) patients had tumor-positive NSN. Univariate analyses showed that primary thickness (Breslow and Clark), primary site, SN tumor size, and number of tumor-positive SNs were significantly associated with tumor-positive NSN. Multivariate analysis (167 patients), confirmed that Breslow and SN tumor size were independently predictive. Sex, histology, ulceration, mitotic index, and SN basin location were not predictive. Risk stratification by the number of prognostic factors present (Breslow ≥ 3 mm and SN tumor size ≥ 2 mm) showed that probability of finding tumor-positive NSN was 12.3% in the low-risk group (0 factors), 30.9% in the intermediate-risk group (1 factor), and 41.9% in the high-risk group (2 factors). Conclusion Thicker primary and larger SN tumor size are factors that correlate best with tumor-positive NSN. Although none of these factors are absolutely predictive of residual nodal disease, these factors must be strongly considered if the SN contains metastasis, as they provide enhanced risk assessment for NSN tumor-positivity.

scholarly journals Recent Advances in the Surgical Treatment of Differentiated Thyroid Cancer: A Comprehensive Review

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Raghunandan Venkat ◽  
Marlon A. Guerrero
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Thyroid Surgery ◽  
Node Dissection ◽  
Central Lymph Node ◽  
Thyroid Cancers ◽  
Perioperative Morbidity ◽  
Central Lymph Node Dissection ◽  
Central Lymph ◽  
Differentiated Thyroid Cancers

Differentiated thyroid cancers have become one of the fastest growing malignancies in the world. While surgery has remained the cornerstone of management of these tumors, the surgical approach has seen numerous innovations over the past few decades. The use of video-assistance and robotics has revolutionized thyroid surgery. This paper provides a comprehensive evaluation of the different approaches to thyroid surgery, the utility of prophylactic and therapeutic lymph node dissection, and evidence-based guidelines in the treatment of differentiated thyroid cancers. Minimally invasive video-ssisted thyroidectomy is both safe and effective in the hands of the trained surgeon and, in selected patient populations, has comparative perioperative morbidity and better cosmesis as compared to conventional open thyroidectomy. It is universally accepted that therapeutic central lymph node dissection should be performed when metastatic lymph nodes are identified on physical exam, ultrasound, or intraoperatively. In the absence of overt nodal metastasis, the role of elective prophylactic central lymph node dissection remains a matter of debate and prospective, randomized studies are warranted to evaluate the utility of this procedure.

scholarly journals Gastric Cancer: 10-Year Survival after Surgery

2021 ◽  
Vol 12 (3) ◽  
pp. 020-032
Author(s):  
Kshivets Oleg
Keyword(s):  
Neural Networks ◽  
Lymph Node ◽  
Blood Cell ◽  
Lymph Node Dissection ◽  
Tumor Size ◽  
Rank Test ◽  
Node Dissection ◽  
Cell Ratio ◽  
Log Rank Test ◽  
Cell Circuit

Methods: We analyzed data of 796 consecutive GCP (age=57.1±9.4 years; tumor size=5.4±3.1 cm) radically operated (R0) and monitored in 1975-2021 (m=556, f=240; distal gastrectomies-G=461, proximal G=165, total G=170, D2 lymph node dissection=551; combined G with resection of 1-7 adjacent organs (pancreas, liver, diaphragm, esophagus, colon transversum, splenectomy, small intestine, kidney, adrenal gland, etc.)=245; D3-4 lymph node dissection=245; only surgery-S=623, adjuvant chemoimmunotherapy-AT=173: 5FU+thymalin/taktivin; T1=237, T2=220, T3=182, T4=157; N0=435, N1=109, N2=252, M0=796; G1=222, G2=164, G3=410; early GC=164, invasive GC=632; Variables selected for 10YS study were input levels of 45 blood parameters, sex, age, TNMG, cell type, tumor size. Survival curves were estimated by the Kaplan-Meier method. Differences in curves between groups of GCP were evaluated using a log-rank test. Multivariate Cox modeling, discriminant analysis, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence. Results: Overall life span (LS) was 2130.8±2304.3 days and cumulative 5-year survival (5YS) reached 58.4%, 10 years – 52.4%, 20 years – 40.4%. 316 GCP lived more than 5 years (LS=4316.1±2292.9 days), 169 GCP – more than 10 years (LS=5919.5±2020 days). 294 GCP died because of GC (LS=640.6±347.1 days). AT significantly improved 10YS (62.3% vs. 50.5%) (P=0.0228 by log-rank test) for GCP. Cox modeling displayed that 10YS of LCP significantly depended on: phase transition (PT) early-invasive GC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, AT, blood cell circuit, prothrombin index, hemorrhage time, residual nitrogen, age, sex, procedure type (P=0.000-0.039). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 10YS and healthy cells/CC (rank=1), PT early-invasive GC (rank=2), PT N0—N12(rank=3), erythrocytes/CC (4), thrombocytes/CC (5), monocytes/CC (6), segmented neutrophils/CC (7), eosinophils/CC (8), leucocytes/CC (9), lymphocytes/CC (10), stick neutrophils/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0). Conclusions: 10-Year survival of GCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) GC characteristics; 9) anthropometric data; 10) surgery type. Optimal diagnosis and treatment strategies for GC are: 1) screening and early detection of GC; 2) availability of experienced abdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunotherapy for GCP with unfavorable prognosis.

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