scholarly journals Prevention of Lymphatic Complications after Pelvic Laparoscopic Lymphadenectomy by Microporous Polysaccharide Absorbable Hemostat

2018 ◽  
Vol 3 (10) ◽  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Preliminary Investigation ◽  
Combined Treatment ◽  
Pelvic Lymphadenectomy ◽  
Long Term Results ◽  
Control Group ◽  
Number Of Patients ◽  
The Impact

Introduction: One of the mandatory components of radical treatment of patients with endometrial cancer is the impact on regional lymph nodes. Nowadays, pelvic lymphadenectomy remains not only therapeutic, but also a diagnostic method in case of predicting the effectiveness of treatment. However, it is important to point out that there are a lot of complications which can occur after dissection of lymph nodes. Lymphorrhea and lymphocele are among the most common postoperative complications of pelvic lymphadenectomy, with a reported incidence of 1% to 50%. Except for the occurrence of undesirable symptoms it can increase the time of drainage standing, which contributes to the delay of further stages of combined treatment. The aim of the study: The aim of the study was to evaluate the effectiveness of the intraoperative application of micro porous polysaccharide absorbable hemostat taking into account the functional outcomes to improve the long-term results of surgical treatment. Materials and methods: In order to solve the tasks, we analyzed the treatment of 12 patients with verified diagnosis of endometrial cancer. We divided the patients in 2 different groups. The first group included patients with polysaccharide absorbable hemostat application (6 patients). The second one (control group) included patients who were provided, according to traditional methods, without using polysaccharide application (6 patients). All patients underwent ultrasound examination on postoperative days 7, 14, 28. Groups were comparable in age, risk profile, and lymph node numbers. Postoperative drain loss and development of early and late lymphocyte were analyzed. Results: Group 1 showed a lower drainage volume and in this group there wasn’t any lymphocyte development. But the control group (group 2) showed 4 occasions of lymphocyte formation. Also two of them were symptomatic and were treated with percutaneous drainage (duration: 25 days in untreated patients versus 7 days in patients with absorbable hemostat using). Conclusion: In this preliminary investigation, the intraoperative application of micro porous polysaccharide absorbable hemostat on lymph node dissection areas significantly decreases total drain loss. In addition, it reduces frequency of lymphocyte formation, which contributes to the timely implementation of further stages of multidisciplinary approach in endometrial cancer’s treatment. A multicenter randomized clinical trial with a larger number of patients and longer follow-up is necessary toevaluate the overall outcomes of the combination of laparoscopic lymphadenectomy plus polysaccharide hemostat application.

scholarly journals T stage-dependent lymph node and distant metastasis and the accuracy of lymph node assessment in rectal cancer

2021 ◽  
Author(s):  
Henry Ptok ◽  
Frank Meyer ◽  
Roland S. Croner ◽  
Ingo Gastinger ◽  
Benjamin Garlipp
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Lymph Nodes ◽  
False Negative ◽  
Cumulative Risk ◽  
Distant Metastases ◽  
Number Of Patients ◽  
Tumor Stages ◽  
The Impact

Summary Objective To analyze data obtained in a representative number of patients with primary rectal cancer with respect to lymph node diagnostics and related tumor stages. Methods In pT2-, pT3-, and pT4 rectal cancer lesions, the impact of investigated lymph nodes on the frequency of pN+ status, the cumulative risk of metachronous distant metastases, and overall survival was studied by means of a prospective multicenter observational study over a defined period of time. Results From 2000 to 2011, the proportion of surgical specimens with ≥ 12 investigated lymph nodes increased significantly, from 73.6% to 93.2% (p < 0.001; the number of investigated lymph nodes from 16.2 to 20.8; p < 0.001). Despite this, the percentage of pN+ rectal cancer lesions varied only non-significantly (39.9% to 45.9%; p = 0.130; median, 44.1%). For pT2-, pT3-, and pT4 rectal cancer lesions, there was an increasing proportion of pN+ findings correlating significantly with the number of investigated lymph nodes up to n = 12 investigated lymph nodes. Only in pT3 rectal cancer was there a significant increase in pN+ findings in case of > 12 lymph nodes (p = 0.001), but not in pT2 (p = 0.655) and pT4 cancer lesions (p = 0.256). For pT3pN0cM0 rectal cancer, the risk of metachronous distant metastases and overall survival did not depend on the number of investigated lymph nodes. Conclusion In rectal cancer, at least n = 12 lymph nodes are to be minimally investigated. The investigation of fewer lymph nodes is associated with a higher risk of false-negative pN0 findings. In particular, in pT3 rectal cancer, the investigation of more than 12 lymph nodes lowers the risk of false-negative pN0 findings. An upstaging effect by the investigation of a possibly maximal number of lymph nodes could not be detected.

P213 PROGNOSTIC SIGNIFICANCE OF CHANGES IN LYMPH NODE MORPHOLOGY ON SURVIVAL IN ESOPHAGEAL CANCER AFTER NEOADJUVANT THERAPY: A SYSTEMATIC REVIEW AND META-ANALYSES

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Hagens Eliza ◽  
Tukanova Karina ◽  
Jamel Sara ◽  
van Berge Henegouwen Mark ◽  
B Hanna George ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Neoadjuvant Therapy ◽  
Tumor Regression ◽  
Average Rate ◽  
Prognostic Significance ◽  
Number Of Patients ◽  
Meta Analyses ◽  
The Impact

Abstract Aim To assess the prognostic significance of lymph node regression or downstaging following neoadjuvant therapy for esophageal cancer. Background and methods The prognostic value of histomorphologic regression in the primary esophageal cancer has been established, whilst the impact of lymph node response on survival still remains unclear. An electronic search was performed to identify articles evaluating lymph node regression or downstaging after neoadjuvant chemo- or chemoradiotherapy. Random effects meta-analyses were performed for regression and downstaging and primary outcome was the hazard ratio (HR) for overall mortality. Survival data were compared between patients with complete regression and those with partial or no response. Histopathological tumor regression in lymph nodes was defined by the absence of viable cells or degree of fibrosis. Furthermore, survival of patients with downstaged lymph nodes to N0 were compared to those with positive nodes following treatment. Results Eight articles were included, 4 of which assessed tumor regression (number of patients=789) and 4 assessing downstaging (number of patients=1937). Complete tumor regression (average rate of 30.0%) in the lymph nodes was associated with higher survival [HR= 0.63, 95% CI (confidence interval) = 0.43 – 0.92; p=0.017] (figure 1). Lymph nodes downstaging (average rate of 47.6%) had improved survival compared to node positivity (HR = 0.38, 95% CI = 0.29 – 0.50; p<0.0001) (figure 2). Conclusion A prognostic benefit was seen in patients with good lymph node response to neoadjuvant therapy, suggesting this should be used as an important additional prognostic marker in staging and in comparative evaluation of different neoadjuvant regimes.

scholarly journals Endometrial Cancer with Sarcoidosis in Regional Lymph Nodes: A Case Report

2015 ◽  
Vol 8 (3) ◽  
pp. 409-415 ◽  
Author(s):  
Satoshi Tamauchi ◽  
Yuji Shimomura ◽  
Hiromi Hayakawa
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Pelvic Lymphadenectomy ◽  
Preoperative Imaging ◽  
Endometrioid Adenocarcinoma ◽  
Regional Lymph Nodes ◽  
Lymph Node Swelling ◽  
Histological Confirmation ◽  
Noncaseating Granulomas

Sarcoidosis is a chronic, multisystemic disease commonly affecting the lungs and lymphatic system and is characterized by the formation of noncaseating granulomas. Although several reports are available on cases developing both sarcoidosis and cancer metachronously, cases of simultaneous diagnosis of these diseases have rarely been reported. A 67-year-old woman diagnosed with endometrial cancer had developed systemic lymph node swelling, including bilateral hilar, paraaortic, and a few pelvic lymph nodes, as observed on preoperative imaging. During surgery, frozen sections of a paraaortic lymph node were examined, revealing noncaseating granulomas compatible with sarcoidosis. Next, modified radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy were performed. Postoperative pathological analysis revealed endometrioid adenocarcinoma of the uterus, and no metastasis but noncaseating granulomas were detected in the resected lymph nodes. Postoperatively, we identified cutaneous sarcoidosis and uveitis in the presence of a tuberculin-negative test. On the basis of these findings, we diagnosed the patients with endometrial cancer complicated by sarcoidosis. She underwent adjuvant chemotherapy, and at the 1-year follow-up, the lymph node swelling due to sarcoidosis was stable, and no recurrence of the cancer was observed. This turned out to be a case of early endometrial cancer mimicking advanced cancer by sarcoidosis. Histological confirmation and additional examination for sarcoidosis are necessary in cancer patients suspected of sarcoidosis.

scholarly journals Diagnostic Accuracy and Clinical Impact of Sentinel Lymph Node Sampling in Endometrial Cancer at High Risk of Recurrence: A Meta-Analysis

2020 ◽  
Vol 9 (12) ◽  
pp. 3874
Author(s):  
Lise Lecointre ◽  
Massimo Lodi ◽  
Émilie Faller ◽  
Thomas Boisramé ◽  
Vincent Agnus ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Endometrial Cancer ◽  
Lymph Node ◽  
High Risk ◽  
Sentinel Lymph Node ◽  
Meta Analysis ◽  
False Negative ◽  
False Negative Rate ◽  
Number Of Patients ◽  
The Impact

Purpose. To assess the value of sentinel lymph node (SLN) sampling in high risk endometrial cancer according to the ESMO-ESGO-ESTRO classification. Methods. We performed a comprehensive search on PubMed for clinical trials evaluating SLN sampling in patients with high risk endometrial cancer: stage I endometrioid, grade 3, with at least 50% myometrial invasion, regardless of lymphovascular space invasion status; or stage II; or node-negative stage III endometrioid, no residual disease; or non-endometrioid (serous or clear cell or undifferentiated carcinoma, or carcinosarcoma). All patients underwent SLN sampling followed by pelvic with or without para-aortic lymphadenectomy. Results. We included 17 original studies concerning 1322 women. Mean detection rates were 89% for unilateral and 68% for bilateral. Pooled sensitivity was 88.5% (95%CI: 81.2–93.2%), negative predictive value was 96.0% (95%CI: 93.1–97.7%), and false negative rate was 11.5% (95%CI: 6.8; 18.8%). We noted heterogeneity in SLN techniques between studies, concerning the tracer and its detection, the injection site, the number of injections, and the surgical approach. Finally, we found a correlation between the number of patients included and the SLN sampling performances. Discussion. This meta-analysis estimated the SLN sampling performances in high risk endometrial cancer patients. Data from the literature show the feasibility, the safety, the limits, and the impact on surgical de-escalation of this technique. In conclusion, our study supports the hypothesis that SLN sampling could be a valuable technique to diagnose lymph node involvement for patients with high risk endometrial cancer in replacement of conventional lymphadenectomy. Consequently, randomized clinical trials are necessary to confirm this hypothesis.

scholarly journals Nanoparticles can improve the positive rate of metastatic lymph node in thyroid cancer surgery

2020 ◽  
Author(s):  
Xindi Su ◽  
Fang Chai ◽  
Benrui Lin ◽  
Lu Qu ◽  
Keyi Liu ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Metastatic Lymph Node ◽  
Cancer Surgery ◽  
Control Group ◽  
Blood Calcium ◽  
Metastatic Lymph ◽  
Positive Rate ◽  
Experimental Group

Abstract Objective. To investigate the application of carbon nanoparticles in lymph node dissection and parathyroid gland protection during thyroid cancer surgery. Subjects and Methods. Retrospective analysis was performed on 282 cases of thyroid cancer surgery in our hospital from 2018 to 2019. All patients underwent total thyroidectomy and cervical central lymph node dissection. Nanocarbon was not used in the control group, but was used in the experimental group. The general situation of the patients, the number of postoperative lymph nodes and the number of metastasis were collected, and the differences between serum parathyroid hormone and blood calcium were compared before and on the 3rd and 30th day after surgery. Results. There was no difference in age, sex and TNM stage between the two groups (P > 0.05). The number of metastatic lymph nodes in the experimental group (9.80 ± 4.80) was different from that in the control group (6.95 ± 3.86) (P < 0.05), and the number of metastatic lymph nodes in the experimental group was different from that in the control group (χ2 = 14.968, P < 0.05). There was no difference in blood calcium and PTH between the two groups before and at 3 and 30 days after surgery (P > 0. 05). Conclusion. The application of carbon nanoparticles in thyroid cancer surgery can significantly increase the number of lymph nodes seized and the positive rate of metastatic lymph node removal, but the protection of parathyroid gland is not obvious.

Post-chemotherapy modified template retroperitoneal lymph node dissection in patients with nonseminomatous germ cell tumours

2021 ◽  
Author(s):  
Murat Zor ◽  
Sercan Yilmaz ◽  
Bahadir Topuz ◽  
Engin Kaya ◽  
Serdar Yalcin ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Germ Cell ◽  
Residual Disease ◽  
Germ Cell Tumors ◽  
Operation Time ◽  
Long Term Results ◽  
Perioperative Outcomes ◽  
Retroperitoneal Lymph Node Dissection

Abstract Introduction/background: Although a full bilateral template RPLND is thought to be the standard of care for the management of postchemotherapy retroperitoneal residual masses for nonseminomatous germ cell tumors (NSGCT), in the past decade modified templates have become increasingly popular. In this study, we aimed to present our oncological and perioperative outcomes of consecutive seventeen NSGCT patients who underwent a modified template unilateral PC-RPLND for retroperitoneal residual disease. Materials and Methods: We retrospectively evaluated the medical records of 17 consecutive NSGCT patients who underwent modified template unilateral PC-RPLND in our university hospital between 2017 and 2020. All patients had normal serum tumour markers with residual disease in the retroperitoneum. Surgical characteristics including the size of the retroperitoneal residual mass, residual tumor pathology, removed lymph nodes, positive percentage of removed lymph nodes, accompanying operations, complications, mean operation time and hospital stay, and long-term results including survival and antegrade ejaculation were evaluated. Results: Eleven patients underwent left and six right-sided surgery. Median residual lymph node diameter was 41mm. Median hospitalisation time was 3.5 days. Median follow-up time was 10.5 months. Necrosis/fibrosis was seen in 6 patients, and teratoma in 11 patients. No viable tumour was seen. No patients died in the follow-up period. None of the patients relapsed during follow-up. Ten/seventeen patients had antegrade ejaculation. Conclusions: Modified template unilateral PC-RPLND leads to very good oncological outcomes with decreased perioperative morbidity as well as better antegrade ejaculation rates. Low volume retroperitoneal disease seems to fit this procedure best.

Impact of Medicaid expansion on pancreatic cancer care: A difference-in-difference analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18567-e18567
Author(s):  
Ahmad Hamad ◽  
Mariam Eskander ◽  
Yaming Li ◽  
Oindrila Bhattacharyya ◽  
James L Fisher ◽  
...  
Keyword(s):  
Low Income ◽  
Early Stage ◽  
Ductal Adenocarcinoma ◽  
Control Group ◽  
Medicaid Expansion ◽  
Difference In Difference ◽  
Post Surgery ◽  
Number Of Patients ◽  
The Impact ◽  
Expansion Period

e18567 Background: The Affordable Care Act (ACA) increased insurance coverage for low-income individuals, which should potentially lead to better access to care and improved oncological outcomes. This study seeks to evaluate the impact of Medicaid expansion (ME) on care for pancreatic ductal adenocarcinoma (PDAC). Methods: Patients who were uninsured or on Medicaid and diagnosed with PDAC between 2004 and 2017 were queried from the National Cancer Database (NCDB). Two different expansion cohorts were included: early expansion states and 2014 expansion states. For early expansion states, the time period of pre-expansion was 2004-2009 and post-expansion was 2010-2017. As for the 2014 expansion states, the pre-expansion period was from 2004-2013 and post-expansion period was from 2014-2017. Patients in non-expansion states formed the control group. A difference-in-difference (DID) analysis was used to assess the association of ME with stage of diagnosis, treatment and survival for each expansion cohort. Results: In both early and January 2014 expansion states, there was an increase in overall Medicaid coverage (Early: DID = 0.29, 2014: DID = 0.37; P < 0.001), in particular for non-Hispanic Black and Hispanic Black patients (Non-Hispanic Black: Early: DID = 0.11, 2014: DID = 0.11; P < 0.001, Hispanic-Black: 2014: DID = 0.20; P = 0.003). There were no differences in early stage diagnosis (Early: DID = 0.02, 2014: DID = -0.02; P > 0.05). There was an increase in the number of patients receiving surgery (Early: DID = 0.05; P = 0.001, 2014: DID = 0.03; P = 0.029) but no difference in time to surgery among patients receiving surgery upfront (Early: DID = 1.75, 2014: DID = 0.38; P > 0.05). There was no difference in 30-day readmission post-surgery (Early: DID = 0.003; 2014: DID = -0.00007; P > 0.05) or 90-day mortality (Early: DID = -0.007, 2014: DID = -0.035; P > 0.05). Moreover, there was no difference in receipt of chemotherapy (Early: DID = 0.01, 2014: DID = 0.005; P > 0.05) or time to chemotherapy for patients receiving neoadjuvant chemotherapy (Early: Early: DID = 9.62, 2014: DID = 0.01; P > 0.05). Finally, there was no difference in receipt of palliative care among stage IV patients in both cohorts (Early: DID = -0.004, 2014: DID = 0.004; P > 0.05). Conclusions: This study suggests that after ME, PDAC patients were more likely to be insured and had increased access to surgical care. Future, studies should evaluate the implications of improved surgical access on clinical outcomes such as mortality.

Treatment Methods for Different Variations Syndrome Mirizzi

2021 ◽  
Vol 04 (04) ◽  
Author(s):  
Omarov N.B., Aimagambetov M. Zh. ◽  
◽  
◽  
Keyword(s):  
Surgical Treatment ◽  
Bile Ducts ◽  
Gallstone Disease ◽  
Main Group ◽  
Mirizzi Syndrome ◽  
Long Term Results ◽  
Control Group ◽  
Type Iii ◽  
Type Iv ◽  
Number Of Patients

The number of patients with complicated forms of cholelithiasis of cholelithiasis is progressively growing. One of the complications of gallstone disease is Mirizzi syndrome (SM). The reason for the development of which is the spread of the inflammatory - destructive process from the gallbladder to the bile ducts with the formation of pressure ulcers in the common bile duct, as a result of which the formation of a cholecystobiliary fistula occurs, through which stones from the gallbladder enter the main bile ducts. The analysis of the surgical treatment of patients with cholelithiasis (GSD) treated in the UH NJSC "MUS" was carried out. There were 3842 patients in total, Patients were in the period from January 2012. to July 2018 The analysis revealed that of all these patients with gallstones, Mirizzi SM type III and IV syndrome was diagnosed in 25 (0.7%). In 14 (56%) patients with type III SM and type IV SM, 11 (44%). The main group consisted of 10 (40%) patients and 15 (60%) patients included in the control group. The main group completed: 1) In type III SM (only 4 (40%) patients). One patient underwent hepaticojejunostomy according to the clinic method (2017/0423.1). In 3 patients, cholecystohepaticocholedochoplasty was performed with U-shaped interrupted sutures on the drainage according to Vishnevsky (2017 / 0980.1); 2) In type IV SM (a total of 6 (60%) patients). 4 patients underwent hepaticojejunostomy according to the clinic method (2017/0423.1). In 2 patients, cholecystohepaticocholedochoplasty was performed with U-shaped interrupted sutures on the drainage according to Vishnevsky (2017 / 0980.1). The developed and tested methods of surgical treatment of Mirizzi syndrome of types III and IV make it possible to improve the immediate and long-term results of surgical treatment of patients with this pathology. These methods of surgical treatment allow preserving the physiology of the bile outflow without postoperative complications typical for traditional hepaticojejunostomy (incompetence of the anastomotic sutures, stricture of hepaticojejunostomy).

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