scholarly journals Medial Inguino-Femoral Lymphadenectomy for Vulvar Cancer: An Approach to Decrease Lymphedema without Compromising Survival

Cancers ◽  
2021 ◽  
Vol 13 (22) ◽  
pp. 5806
Author(s):  
Neville F. Hacker ◽  
Ellen Barlow ◽  
Stephen Morrell ◽  
Katrina Tang
Keyword(s):  
Lymph Nodes ◽  
Femoral Artery ◽  
Lower Limb ◽  
Vulvar Cancer ◽  
Node Dissection ◽  
Lateral Node ◽  
Lateral Border ◽  
Lateral Group

Background: Lower limb lymphedema is a long-term complication of inguino-femoral lymphadenectomy and is related to the number of lymph nodes removed. Our hypothesis was that lymph nodes lateral to the femoral artery could be left in situ if the medial nodes were negative, thereby decreasing this risk. Methods: We included patients with vulvar cancer of any histological type, even if the cancer extended medially to involve the urethra, anus, or vagina. We excluded patients whose tumor extended (i) laterally onto the thigh, (ii) posteriorly onto the buttocks, or (iii) anteriorly onto the mons pubis. After resection, the inguinal nodes were divided into a medial and a lateral group, based on the lateral border of the femoral artery. Results: Between December 2010 and July 2018, 76 patients underwent some form of groin node dissection, and data were obtained from 112 groins. Approximately one-third of nodes were located lateral to the femoral artery. Positive groin nodes were found in 29 patients (38.2%). All patients with positive nodes had positive nodes medial to the femoral artery. Five patients (6.6%) had positive lateral inguinal nodes. The probability of having a positive lateral node given a negative medial node was estimated to be 0.00002. Conclusion: Provided the medial nodes are negative, medial inguino-femoral lymphadenectomy may suffice and should reduce lower limb lymphedema without compromising survival.

Long term outcomes in patients with sentinel lymph nodes (SLNs) identified by injecting remaining scar after previously excised vulvar cancer

2019 ◽  
Vol 155 (1) ◽  
pp. 83-87
Author(s):  
Andra Nica ◽  
Allan Covens ◽  
Danielle Vicus ◽  
Rachel Kupets ◽  
Lilian T. Gien
Keyword(s):  
Lymph Nodes ◽  
Vulvar Cancer ◽  
Sentinel Lymph Nodes ◽  
Long Term Outcomes

scholarly journals Anatomic Extent of Pelvic Lymph Node Dissection: Impact on Long-term Cancer-specific Outcomes in Men With Positive Lymph Nodes at Time of Radical Prostatectomy

Urology ◽  
2013 ◽  
Vol 82 (3) ◽  
pp. 653-659 ◽  
Author(s):  
Trinity J. Bivalacqua ◽  
Phillip M. Pierorazio ◽  
Michael A. Gorin ◽  
Mohamad E. Allaf ◽  
H. Ballentine Carter ◽  
...  
Keyword(s):  
Lymph Node ◽  
Radical Prostatectomy ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Pelvic Lymph Node Dissection ◽  
Pelvic Lymph Node ◽  
Node Dissection ◽  
Positive Lymph Nodes

Technique for inguino-femoral lymph node dissection in vulvar cancer: an international survey

2021 ◽  
pp. ijgc-2021-002452
Author(s):  
Sadie Esme Fleur Jones ◽  
Pedro T Ramirez ◽  
Geetu Prakash Bhandoria ◽  
Heng-Cheng Hsu ◽  
Navya Nair ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Saphenous Vein ◽  
Practice Patterns ◽  
Vulvar Cancer ◽  
Gynecologic Oncology ◽  
Node Dissection ◽  
Time Of Surgery ◽  
Oblique Incision

BackgroundVulvar cancer is a rare disease and despite broad adoption of sentinel lymph node mapping to assess groin metastases, inguino-femoral lymph node dissection still plays a role in the management of this disease. Inguino-femoral lymph node dissection is associated with high morbidity, and limited research exists to guide the best surgical approach.ObjectiveTo determine international practice patterns in key aspects of the inguino-femoral lymph node dissection technique and provide data to guide future research.MethodsA survey addressing six key domains of practice patterns in performing inguino-femoral lymph node dissection was distributed internationally to gynecologic oncology surgeons between April and October 2020. The survey was distributed using the British Gynecological Cancer Society, the Society of Gynecologic Oncology, authors' direct links, the UK Audit and Research in Gynecology Oncology group, and Twitter.ResultsA total of 259 responses were received from 18 countries. The majority (236/259, 91.1%) of respondents reported performing a modified oblique incision, routinely dissecting the superficial and deep inguino-femoral lymph nodes (137/185, 74.1%) with sparing of the saphenous vein (227/258, 88%). Most respondents did not routinely use compression dressings/underwear (169/252 (67.1%), used prophylactic antibiotics at the time of surgery only (167/257, 65%), and closed the skin with sutures (192 74.4%). Also, a drain is placed at the time of surgery by 243/259 (93.8%) surgeons, with most practitioners (144/243, 59.3%) waiting for drainage to be less than 30–50 mL in 24 hours before removal; most respondents (66.3%) routinely discharge patients with drain(s) in situ.ConclusionOur study showed that most surgeons perform a modified oblique incision, dissect the superficial and deep inguino-femoral lymph nodes, and spare the saphenous vein when performing groin lymphadenectomy. This survey has demonstrated significant variability in inguino-femoral lymph node dissection in cases of vulvar cancer among gynecologic oncology surgeons internationally.

Clonal Evolution During Long-Term Follow-up Using Fluorescent in-Situ Hybridisation (FISH) in Chronic Lymphocytic Leukemia.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4218-4218
Author(s):  
Stefan Norin ◽  
Mohit Aggarwal ◽  
Ann Wallblom ◽  
Eva Kimby
Keyword(s):  
Lymph Nodes ◽  
Chromosomal Aberrations ◽  
Clonal Evolution ◽  
In Situ Hybridisation ◽  
Fish Analysis ◽  
Fish Sample ◽  
Long Term Follow Up

Abstract Abstract 4218 Background The prognostic importance of certain chromosomal abnormalities in CLL is well-known. It is also established knowledge that deletions of the short arm of chromosome 17, del(17p), is more commonly found in chemoresistant patients. However, there is still uncertainty on how findings of small clones should be interpreted and only scarce sequential data of existing clones and emergence of new aberrations. Aim To evaluate the chromosomal aberrations del(13q), del(11q), del(17p) and trisomy 12 (+12) during the course of the disease with fluorescent in-situ hybridisation (FISH), with focus on the emergence of new clones and progression of existing clones. Patients and methods All patients from Karolinska University Hospital, Huddinge, diagnosed with CLL between 1983-2007 and with at least two FISH analyses on blood or bone marrow at different time points during the course of the disease were selected for further prospective samples (also from lymph nodes and spleen). In total 168 samples from 51 patients have been analysed (≥ 3 samples in 32 patients). Median age at diagnosis was 59 (range 35-77) years. The first FISH sample was taken at diagnosis in 25 patients, before any therapy in further 17 patients, and in the remaining 9 patients after therapy. Median time between the first and last FISH sample was 44 (range 4-300) months. Before the last FISH analysis totally 34 patients had been treated with purine analogs (n=13), alemtuzumab (n=5) and both these drugs (n=10). The remaining six patients were treated with alkylator-based therapy only. Results At the first FISH analysis, all but two patients had at least one aberration (96%) using a 5% cut-off; 23 with a single abnormality, del(13q) in 13 cases, del(17p) in 4 cases and +12 and del(11q) in 3 cases each. A combination of two or three aberrations was found in 26 patients. In total the most common aberration was del(13q) (n=32). Del (17p) was found in 24 patients and del(11q) and +12 in 18 and 7 patients, respectively. Clones affecting more than 50% of the cells were mostly stable during follow-up, which was also the case for small clones (≤20% of the cells) with del (17p) in 17 out of 19 cases. However, a small del(13q) clone progressed in 3 out of 9 such cases. New clones appeared during the course of the disease in 15 patients (29%); five new del(17p), two +12 and four cases each with del(13q) and (11q). All patients except four had been treated before the new clone emerged. New aberrations in these four untreated patients were del (17p) (n=2), del (13p) (n=1) and +12 (n=1). New clones did affect > 20% of the cells in only four cases; 2 del(13q) and 2 del(11q). Sequential analyses of chromosomal aberrations with FISH during long-term follow-up of CLL patients show a low likelihood of progression of small del(17p) clones, but a clonal evolution in a third of patients including all the analysed aberrations. Further FISH analyses from spleen and lymph nodes will be presented at the ASH meeting. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Long term outcomes from lymphatic venous anastomosis after total hysterectomy to prevent postoperative lymphedema in lower limb

BMC Surgery ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Masahiro Ezawa ◽  
Hiroshi Sasaki ◽  
Kyosuke Yamada ◽  
Hirokuni Takano ◽  
Tsuyoshi Iwasaka ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Lower Limb ◽  
Abdominal Hysterectomy ◽  
Node Dissection ◽  
Long Term Outcomes ◽  
Venous Anastomosis ◽  
Total Hysterectomy ◽  
Sleeve Anastomosis

Abstract Background Lymphedema in lower limb is one of major postoperative complications followed by a total hysterectomy with lymph node dissection. The objective of this report is to examine a long-term result of lymphaticovenous anastomosis procedure as a preventive surgery. Methods Sixteen patients with endometrial cancer underwent an abdominal hysterectomy with a bilateral salpingo-oophorectomy. Just after pelvic lymph node dissection, either end-to-end or sleeve anastomosis utilizing venules and suprainguinal lymph vessels was performed. During the observation period from 4 to 13 years, the symptom of lymphedema in lower extremities has been assessed. Results Among 16 patients, 1 presented postoperative lymphedema grade 3 (CTCAE (Common Terminology Criteria for Adverse Events) Ver. 4.0, 10025233) in lower limb, and a second surgery at 7 years after the first one was required. Other 6 patients showed non-severe symptoms of lymphedema, diagnosed as grade 1. The rest 9 patients did not show any symptoms of postoperative lymphedema in a long term (up to 13 years). Conclusion From the long term outcomes of our 16 cases, we propose that a direct lymphaticovenous microsurgery immediately after a hysterectomy with lymphadenectomy of external inguinal lymph node is one of the appropriate therapeutic choices to prevent severe lymphedema in lower limb.

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