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

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.

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 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.

scholarly journals Safety and Feasibility of No.12a Lymph Node Dissection by Portal Vein Approach in Radical Laparoscopic Gastrectomy for Gastric Cancer

2020 ◽  
Vol 19 ◽  
pp. 153303382097127
Author(s):  
Hai-Peng Huang ◽  
Wen-Jun Xiong ◽  
Yao-Hui Peng ◽  
Yan-Sheng Zheng ◽  
Li-Jie Luo ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Blood Loss ◽  
Portal Vein ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Intraoperative Blood Loss ◽  
Node Dissection ◽  
Metastasis Rate ◽  
The Mean

Background: Traditional laparoscopic No.12a lymph node dissection in radical gastrectomy for gastric cancer may damage the peripheral blood vessels, and is not conducive to the full exposure of the portal vein and the root ligation of the left gastric vein. We recommend a new surgical procedure, the portal vein approach, to avoid these problems. Methods: 25 patients with advanced gastric cancer underwent radical laparoscopic gastrectomy and No.12a lymph node were dissected by portal vein approach, including 7 cases with total gastrectomy, 18 cases with distal gastric resection, 14 males and 11 females. Operative time, intraoperative blood loss, time to first flatus, postoperative hospital stay, number of total lymph node dissection and No.12a lymph node dissection, No.12a lymph node metastasis rate and postoperative complications were statistically observed. Results: All the patients were operated successfully and No.12a lymph node were cleaned by portal vein approach. A total of 683 lymph nodes were dissected, with the average number of lymph nodes dissection and positive lymph nodes were (27.3 ± 12.7) and (3.8 ± 5.6) respectively. The average number of No.12a lymph node dissection was (2.4 ± 1.95) and the metastasis rate of No.12a lymph node was 16% (4/25). The average operation time of radical laparoscopic distal and total gastrectomy were (239.2 ± 51.4) min and (295.1 ± 27.7) min respectively. The mean intraoperative blood loss was (134.0 ± 65.7) ml, and postoperative first anal exhaust time was (2.24 ± 0.86) d. The mean time to fluid intake was (4.2 ± 1.7) d, and postoperative hospitalization time was (9.6 ± 5.0) d. Without portal vein injure, anastomotic leakage, gastrointestinal bleeding, intestinal obstruction and other complications were observed in all patient. Conclusion: Our results show that the laparoscopic No.12a lymph node dissection by portal vein approach for gastric cancer is safe, feasible and has certain clinical application value.

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