retroperitoneal lymph node dissection
Recently Published Documents


TOTAL DOCUMENTS

1053
(FIVE YEARS 203)

H-INDEX

62
(FIVE YEARS 4)

Author(s):  
Tomoyuki Nagai ◽  
Muneaki Shimada ◽  
Hideki Tokunaga ◽  
Mitsuya Ishikawa ◽  
Nobuo Yaegashi

Abstract Objective The mainstay of treatment for uterine endometrial cancer is surgery, and recurrent-risk cases require multidisciplinary treatment, including surgery, chemotherapy and radiation therapy. Methods The standard surgery for uterine endometrial cancer is hysterectomy and bilateral salpingooophorectomy, with additional retroperitoneal lymph node dissection and omentectomy, depending on the case. The appropriate treatment is determined based on the risk classification, such as the depth of invasion into the myometrium, diagnosis of histological type and grade, and risk assessment of lymph node metastasis. Results Recently, minimally invasive surgery has been widely used not only in low-risk patients but also in intermediate- and high-risk patients. In low-risk patients, the possibility of ovarian preservation is discussed from a healthcare perspective for young women. Determining the need for retroperitoneal lymph node dissection based on sentinel lymph node evaluation may contribute in minimizing the incidence of post-operative lymphedema while ensuring accurate diagnosis of lymph node metastasis. Recently, many studies using sentinel lymph nodes have been reported for patients with uterine endometrial cancer, and the feasibility of sentinel lymph node mapping surgery has been proven. Unfortunately, sentinel lymph node biopsy and sentinel lymph node mapping surgery have not been widely adopted in surgery for uterine cancer in Japan. In addition, the search for biomarkers, such as RNA sequencing using The Cancer Genome Atlas, metabolic profile and lipidomic profile for early detection and prognostic evaluation, has been actively pursued. Conclusions Gynecologic oncologists expect to be able to provide uterine endometrial cancer patients with appropriate treatment that preserves their quality of life without compromising oncologic outcomes in the near future.


2022 ◽  
Vol 12 ◽  
Author(s):  
Bingqing Shang ◽  
Chuanzhen Cao ◽  
Weixing Jiang ◽  
Hongzhe Shi ◽  
Xingang Bi ◽  
...  

BackgroundTesticular sex cord stromal tumours (TSCSTs) are rare, with few studies focusing on the metastatic TSCST prognosis. The value of treatments, including radical orchiectomy (RO) and retroperitoneal lymph node dissection (RPLND), in preventing metastasis is controversial. Additionally, metastatic TSCSTs are resistant to chemotherapy. We aimed to assess the effectiveness and safety of immunotherapy in metastatic TSCSTs after first-line chemotherapy.MethodsWe retrospectively screened patients with testicular tumours undergoing testis surgery between January 2005 and January 2019. Patients with TSCSTs who had undergone testis-sparing surgery (TSS) or RO were identified. The malignant type was defined as metastasis confirmed by pathology. Treatment responses, progression-free survival (PFS), overall survival (OS) and safety were analysed.ResultsAmong the 494 testicular tumour patients who received TSS or RO, 11 (2.2%) patients with histologically proven TSCSTs were identified. At the last follow-up, 7 patients survived without tumours, and 4 patients developed metastasis and received first-line cisplatin-based chemotherapy, with 1 of them achieving an objective response. Their PFS times were 1.5, 2.2, 9.0, and 17.0 months, respectively. Two patients received immune checkpoint inhibitors (ICIs) after developing chemotherapy resistance and achieved a partial response up to the last follow-up; one of them experienced Grade 1 adverse events, and the other experienced Grade 2 adverse events during immunotherapy. The median OS time of the 4 patients with metastatic TSCSTs was 32 months.ConclusionsTSCSTs are rare, and most are benign with a good prognosis. ICIs represent a promising option for improving clinical outcomes in metastatic TSCSTs.


Author(s):  
Julia Heinzelbecker ◽  
Stefanie Schmidt ◽  
Julia Lackner ◽  
Jonas Busch ◽  
Carsten Bokemeyer ◽  
...  

Abstract Purpose The optimal treatment for clinical stage (CS) IIA/IIB seminomas is still controversial. We evaluated current treatment options. Methods A systematic review was performed. Only randomized clinical trials and comparative studies published from January 2010 until February 2021 were included. Search items included: seminoma, CS IIA, CS IIB and therapy. Outcome parameters were relapse rate (RR), relapse-free (RFS), overall and cancer-specific survival (OS, CSS). Additionally, acute and long-term side effects including secondary malignancies (SMs) were analyzed. Results Seven comparative studies (one prospective and six retrospective) were identified with a total of 5049 patients (CS IIA: 2840, CS IIB: 2209). The applied treatment modalities were radiotherapy (RT) (n = 3049; CS IIA: 1888, CSIIB: 1006, unknown: 155) and chemotherapy (CT) or no RT (n = 2000; CS IIA: 797, CS IIB: 1074, unknown: 129). In CS IIA, RRs ranged from 0% to 4.8% for RT and 0% for CT. Concerning CS IIB RRs of 9.5%–21.1% for RT and of 0%–14.2% for CT have been reported. 5-year OS ranged from 90 to 100%. Only two studies reported on treatment-related toxicities. Conclusions RT and CT are the most commonly applied treatments in CS IIA/B seminoma. In CS IIA seminomas, RRs after RT and CT are similar. However, in CS IIB, CT seems to be more effective. Survival rates of CS IIA/B seminomas are excellent. Consequently, long-term toxicities and SMs are important survivorship issues. Alternative treatment approaches, e.g., retroperitoneal lymph node dissection (RPLND) or dose-reduced sequential CT/RT are currently under prospective investigation.


2021 ◽  
Author(s):  
Murat Zor ◽  
Sercan Yilmaz ◽  
Bahadir Topuz ◽  
Engin Kaya ◽  
Serdar Yalcin ◽  
...  

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.


2021 ◽  
Vol 33 ◽  
pp. S58
Author(s):  
A. Oluwole-Ojo ◽  
B. Challacombe ◽  
Y. Abu Ghanem ◽  
S. Rudman ◽  
H. Verma ◽  
...  

2021 ◽  
Vol 11 (2) ◽  
pp. 27-37
Author(s):  
V. B. Matveev ◽  
M. I. Volkova ◽  
G. A. Arakelyan ◽  
I. A. Feinstein ◽  
Yu. S. Sergeev ◽  
...  

Objective: To evaluate the results of retroperitoneal lymph node dissection (RPLND) in patients with advanced non-seminomatous germ cell testicular tumors (NSGCT) and incomplete serological and radiological response to chemotherapy (CT).Materials and methods: The study included 96 patients with advanced NSGCT who underwent RPLND in N.N. Blokhin Russian Cancer Research Center in 1983-2020. The median age was 27 (15-57) years. All patients (n = 96, 100,0 %) received first-line cisplatin-based CT. Fifty-eight patients (60,4%) received second-line CT. After completion of CT, all patients presented with elevated levels of AFP and/or hCG and detectable tumor lesions (retroperitoneal metastases only in 77 cases (80,2 %), metastases in the retroperitoneal space and other sites in 19 cases (19,8%)). All patients underwent the follow-up surgery after CT completion: RPLND in 96 cases (100,0%) and resection of extra-retroperitoneal lesions in addition to RPLND in 8 cases (8,3%). In total, 29 (30,2%) of 96 patients received CT following surgery. The median follow-up was 39,4 (1-284) months.Results: Postoperative complications were reported in 10 (10,6%) patients, including grade 3-4 in 3 patients (3,1%). The mortality rate was 1,1%. The complete resection of retroperitoneal tumor lesions was performed in 80 cases (83,3 %), resection of all detectable tumor lesions in 69 cases (71,9%). None of the patients achieved complete response to postoperative CT. Pathological examination of retroperitoneal lesions revealed necrosis and fibrosis, teratomas, and malignant non-seminomatous tumors in 25 (26,0 %), 29 (30,2 %), and 42 (43,8 %) cases, respectively. The long-term overall survival (OS) and cancer-specific survival rates were 60,9 % and 61,7 %, respectively. The relapse-free survival rate in patients who underwent complete resection reached 65,2 %, the progression-free survival rate in patients who underwent incomplete resection was 35,9 %. A multivariate analysis revealed the following independent predictors of unfavorable OS: RPLND after second-line CT (odds ratio [OR] 4,667 (95% confidence interval [CI]: 1,987-10,961)), presence of a residual retroperitoneal mass of a malignant non-seminomatous tumor (OR 3,081 (95% CI: 1,178-8,055), and incomplete removal of residual lesions after CT (OR 4,445 (95% CI: 1,813-10,899)).Conclusion: Post-CT RPLND may be considered a viable option in the selected group of advanced NSGCT patients with an incomplete serological response to CT eligible for complete resection of all detectable tumor lesions.


Sign in / Sign up

Export Citation Format

Share Document