Aortic Node Metastasis Research Articles

245. CONVERSION SURGERY AFTER DEINITIVE CHEMORADIOTHERAPY FOR THORACIC ESOPHAGEAL CANCER

Abstract Background Definitive chemoradiotherapy (dCRT) is an important treatment option for cStage III/IVa esophageal cancer. In our hospital, dCRT is the treatment of choice for cT4b. In this study, we investigated the technique, prognosis, and postoperative complications of salvage surgery after dCRT, with the aim of gaining knowledge to achieve both cure and safety. Methods The study included 36 patients who underwent conversion surgery after dCRT for thoracic esophageal cancer with suspected invasion of other organs between April 2012 and June 2021. The median age was 68 years (38–80 years). cT4b invasive organs were trachea and left main bronchus in 21 cases, aorta in 11 cases, and other organs in 4 cases. Thoracoscopic esophagectomy was performed in 13 patients. Reconstruction of the gastrointestinal tract via the posterior sternal route was the basic procedure. Resluts There was one case of death in hospital (3%). Postoperative complications (Clavien-Dindo Grade II or higher) were observed in 17 patients (47%), including pneumonia in 9 patients (25%) and suture failure in 5 patients (14%). The median postoperative hospital stay was 17 days. The incidence of postoperative pneumonia was lower in patients with higher preoperative serum Alb and preoperative PNI. The median recurrence-free survival was 14 months. Histopathologically, 7 patients (19%) showed cancerous remnants, and the prognosis was poor in patients with remnant disease, aortic invasion, or preoperative lymph node metastasis. Conclusion Perioperative outcomes were considered acceptable. Down staging is likely to be achieved after dCRT, but preoperative nutritional status should be improved. The prognosis is poor in patients with aortic invasion or lymph node metastasis, and the indication for chemoradiation should be carefully considered. Postoperative adjuvant therapy is an issue for the future.

Effective radiotherapy in rarely observed para-aortic lymph node metastases of sinonasal schwannoma-clinical case from our practice

Schwannoma is benign neurogenic tumor, that arise from Schwann cells of the peripheral nerve sheath. Malignant schwannomas transformation is extremely rare. Histopathological and immunohistochemical analysis confirmed the final pathohistological diagnosis, which is extremely important for the assessment of the therapeutic approach. Schwannomas lymph node metastases are extremely rare and poorly characterized. We present an extremely rare sinonasal schwannoma with metastases in the para-aortic lymph nodes. More interesting is that metastatic para-aortic lymph nodes were affected by radiotherapy . In this article, we share the surprising fact, that the proved through FDG-PET/CT para -aortic lymph node metastases in sinonasal schwannoma with a limitation of more than 3 years, is effectively responded after radiotherapy with total dose over 45 Gy.

PARa-aOrtic LymphAdenectomy in locally advanced cervical cancer (PAROLA trial): a GINECO, ENGOT, and GCIG study

BackgroundPositron emission tomography/computed tomography (PET/CT) fails to detect approximately 25% of aortic lymph node metastasis in patients with PET/CT stage IIIC1 cervical cancer. Surgical staging could lead to treatment modification...

Conventional Laparoscopy versus Robotic-Assisted Aortic Lymph-Nodal Staging for Locally Advanced Cervical Cancer: A Systematic Review and Meta-Analysis.

Aortic lymph node metastases are a relative common finding in locally advanced cervical cancer. Minimally invasive surgery is the preferred approach to perform para-aortic lymph nodal staging to reduce complications, hospital stay, and the time to primary treatment. This meta-analysis (CRD42022335095) aimed to compare the surgical outcomes of the two most advanced approaches for the aortic staging procedure: conventional laparoscopy (CL) versus robotic-assisted laparoscopy (RAL). The meta-analysis was conducted according to the PRISMA guideline. The search string included the following keywords: “Laparoscopy” (MeSH Unique ID: D010535), “Robotic Surgical Procedures” (MeSH Unique ID: D065287), “Lymph Node Excision” (MeSH Unique ID: D008197) and “Aorta” (MeSH Unique ID: D001011), and “Uterine Cervical Neoplasms” (MeSH Unique ID: D002583). A total of 1324 patients were included in the analysis. Overall, 1200 patients were included in the CL group and 124 patients in the RAL group. Estimated blood loss was significantly higher in CL compared with RAL (p = 0.02), whereas hospital stay was longer in RAL compared with CL (p = 0.02). We did not find significant difference for all the other parameters, including operative time, intra- and postoperative complication rate, and number of lymph nodes excised. Based on our data analysis, both CL and RAL are valid options for para-aortic staging lymphadenectomy in locally advanced cervical cancer.

Ongoing 5-year+ survival after multiple metastasectomies, followed by CAPOX plus bevacizumab, for metastatic colorectal cancer

BackgroundAdvancements in chemotherapy for metastatic colorectal cancer (mCRC) have improved long-term outcomes, and median survival currently exceeds 30 months. The recommended treatment for mCRC is multidisciplinary, including a combination of surgical resection and chemotherapy. In this study, we report the case of a patient who has survived for more than 5 years after an initial diagnosis of mCRC while undergoing first-line chemotherapy and six repeat metastasectomies.Case presentationA 55-year-old man was diagnosed at our hospital with sigmoid colon cancer and hepatic metastasis. We performed laparoscopic sigmoidectomy and hepatic segmentectomy (segment 5 [S5] and S8). After resecting the primary tumor and liver metastasis, other metastases were found. Together with perioperative chemotherapy (CAPOX + bevacizumab), we performed repeated metastasectomies for liver metastasis (S4 and S7), pulmonary S1 metastasis, aortic lymph node metastasis, and right adrenal metastasis. With six metastasectomies, the patient has survived for more than 5.5 years.ConclusionsMultidisciplinary treatment extends survival and improves the quality of life in patients with mCRC. Planned surveillance after metastasectomy may also be necessary to promote the early detection of recurrence in these patients.

Conversion Surgery for initially unresectable biliary malignancies. Multicenter retrospective cohort study

Background: Recent reports showed surgery for patients with initially unresectable tumor (so called conversion surgery) could lead selected patients to long-term survival. However, because few reports on conversion surgery for biliary malignancies (intrahepatic cholangiocarcinoma, perihilar cholangiocarcinoma, distal cholangiocarcinoma, gallbladder carcinoma, and papilla of Vater carcinoma) was reported, whether conversion surgery for biliary malignancies could lead long-term survival to patients with unresectable biliary malignancies were unclear. The purposes of this multicenter retrospective cohort study were, first to evaluate surgical results of conversion surgery, and second to evaluate long-term survival. Patients and Method: This study was enrolled by Hokkaido Cholangiocarcinoma study (HOCS) group. A multicenter survey was conducted to collect clinical data on patients with conversion surgery for biliary malignancies. Diagnostic criteria for unresectable with locally advanced were not defined. which were based on each institutional criterion. These were based on each institutional criterion. Para aortic lymph node metastasis were considered distant metastasis, and the other lesions in intrahepatic cholangiocarcinoma were also considered hepatic metastasis. Patients with distant metastasis were considered initially unresectable patients. Results: Twenty-four patients met our inclusion criteria. Median follow up duration from the initial therapy and from conversion surgery were 76.7months (10-163.1) and 70.1 months (0.8-157.1), respectively. Various preoperative chemotherapies or chemoradiation therapies were performed based on institutional criteria. Various surgical procedures were performed based on tumor location. Morbidity were occurred on 16 of 24 patients (66.7%), and one patient died after surgery (due to liver failure). Overall 5-year survival rate after initial therapy were 43.2%, and median survival time was 57.4 months. Overall 5-year survival rate after surgery were 37.9%, and also median survival time was 34.3months. Conclusion: Conversion surgery for initially unresectable biliary malignancies patients would be feasible, because selected patients could have long-term survival after the surgery.

Sentinel lymph nodes (SLN) in endometrial cancer: The relationship between primary tumor histology, SLN metastasis size, and non-sentinel node metastasis

ObjectivesTo examine sentinel lymph node pathology and describe relationships to uterine pathology, non-sentinel pelvic lymph nodes, and para-aortic lymph nodes. MethodsPatients with apparent uterine-confined endometrial cancer underwent robotic hysterectomy, SLN mapping, completion pelvic lymphadenectomy (LND), and para-aortic (PaLND) directed by frozen section. Patients were risk stratified by histology: low-risk (LR) endometrioid <50% depth-of-invasion (DOI), intermediate-risk (IR) endometrioid ≥50% DOI, and high-risk (HR) type II histology for comparison to other pelvic/aortic metastases. Results414 patients were stratified: 275 LR, 80 IR, and 59 HR cases. PaLND was performed in 84.2% of IR/HR patients and 25.1% LR patients. Pelvic node metastasis was detected in 11.6% LR, 50.0% IR, and 39.0% HR patients. PaLN metastasis was detected in 2.9% LR, 11.3% IR, and 16.9% HR patients. Proportionally, isolated tumor cells (ITC) SLNs were more common in LR or IR vs. HR group (51.6% and 44.7% vs. 15.0%, p < 0.05). The SLN false negative rates (FNR) were 0% LR, 2.5% IR, and 5.1% HR. Non-sentinel pelvic node metastases were present in 28(31.5%) of all SLN+ cases, but only 3(8.3%) of SLN with ITC. PaLN metastasis was found in 18.8% LR, 11.8% IR, and 33.3% HR cases with ITC SLNs. After controlling for DOI, LVSI, and grade, ITC-positive SLNs had a significant association with non-sentinel pelvic and aortic metastasis (p = 0.03 and p = 0.008, respectively). ConclusionsPatients with HR histology have more micro/macro-metastases in both SLNs and non-SLN metastases compared to LR/IR patients. SLN ITCs were associated with a clinically significant incidence of PaLN metastasis across all histology risk groups. There were no cases of isolated aortic node metastasis in this study. SLN mapping had an increased, although clinically acceptable FNR in the HR cohort compared to LR patients.

The prognostic significance of aortic lymph node metastasis in endometrial cancer: Potential implications for selective aortic lymph node assessment

ObjectivesTo evaluate the prognostic impact of aortic vs. pelvic lymph node (LN) metastasis among women with endometrial cancer (EC). MethodsUsing data from the SEER 18 Registries we identified 3650 women with LN positive (stage IIIC) EC. We used Kaplan-Meier curves and log-rank tests to compare mortality between women with stage IIIC1 and IIIC2 disease. We used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between stage III sub-stage (IIIC1 vs. IIIC2) and survival. ResultsEndometrioid tumors were more common among women with stage IIIC1 than IIIC2 tumors (62.5% vs. 54.3%) while, non-endometrioid histologies were more common among stage IIIC2. In the multivariable model, stage IIIC2 was associated with higher all-cause (HR = 1.44, 95% CI = 1.22–1.69) and EC-specific mortality (HR = 1.49, 95% CI = 1.25–1.77) compared with IIIC1. Women with non-endometrioid EC had poor survival, in particular, women with carcinosarcomas had higher EC-specific mortality compared to women with endometrioid EC (HR = 3.32, 95% CI = 2.71–4.07). When stratifying women according to substage, older age and non-endometrioid histology were associated with higher EC-specific mortality. Compared to women with a pelvic-only LN dissection, women with pelvic and aortic dissections had lower all-cause (HR = 0.74, 95% CI = 0.63–0.88) and EC-specific (HR = 0.79, 95% CI = 0.66–0.95) mortality. ConclusionWomen with aortic LN positive EC are more likely to die from their disease. Older women and non-endometrioid histologies are more likely to have aortic LN involvement. Compared to women with a pelvic-only LN dissection, women with pelvic and aortic dissections had lower EC mortality.

Prognostic analysis of extended field intensity-modulated radiation therapy for cervical cancer

In recent decades, accurate radiotherapy has developed rapidly, and the application of intensity-modulated radiation therapy (IMRT) in gynecologic malignancies has increased gradually in the past ten years. Many studies have shown a high rate of occult abdominal aortic lymph node metastasis in patients with advanced cervical cancer, while pelvic and abdominal aortic lymph node status are important prognostic factors in cervical cancer patients. Conventional prophylactic extended field radiotherapy has the characteristics of severe gastrointestinal side effects, and synchronic chemotherapy is also controversial. The optimal dose of radiation therapy for metastatic pelvic and abdominal aortic lymph nodes is still controversial. This paper mainly analyzed the effect of prophylactic extended conformal radiotherapy with concurrent chemotherapy on the prognosis of cervical cancer and the dose-effect relationship of lymph node positive region. Key words: Cervical neoplasm/intensity modulated radiation therapy; Extended field radiotherapy; Concurrent chemotherapy; Lymph node; Survival rate

Patrón MELF de infiltración miometrial en el adenocarcinoma endometrioide del endometrio. Revisión de 70 casos

IntroductionEndometrioid adenocarcinoma of the endometrium (EAE) usually has a favorable prognosis. Recently, the MELF (microcystic, elongated and fragmented) pattern of myometrial infiltration has been described. It is associated with lymphovascular invasion and lymph node metastasis. Seventy cases of EAE were reviewed to identify the presence of MELF and its correlation with other prognostic factors. Material and methodsHysterectomies performed for EAE during a 5-year period were reviewed, searching for MELF pattern. Its presence was correlated with other variables such as histological grade, depth of myometrial infiltration, pelvic and/or aortic lymph node metastasis, peritoneal implants and evolution. ResultsIn 17 (24%) cases MELF pattern was detected. It was more frequent in low grade tumors; it was present in four grade 3 cases. In 9 (53%) cases there was deep myometrial infiltration. Five cases had lymph node metastasis in the pelvis and three in the para-aortic region. One of the patients died, another presented a vulvar recurrence and another pulmonary metastasis. ConclusionMELF pattern can be seen in high grade EAE and correlates with deep myometrial infiltration and pelvic lymph node metastasis. Its presence does not seem to influence survival.

Mucinous Adenocarcinoma Arising From Mature Cystic Teratoma with Nodal Metastasis

The most common germ cell tumor of ovary is mature cystic teratoma (MCT). Malignant transformation occurs in 1-2% of the cases, and most of the malignancy from the MCT are squamous cell carcinoma, representing 75% of malignant transformation. The incidence of malignant transformation of adenocarcinoma is rare about 6.8%. Here we present a rare case coexistence of mucinous adenocarcinoma with benign cystic teratoma in the same ovary with omental, pelvic and para aortic node metastasis.

Incidence of nodal metastasis and isolated aortic metastases in patients with surgically staged endometrioid endometrial cancer.

To describe the incidence of lymph node metastasis in patients with surgically staged endometrioid-type endometrial cancer in Donostia University Hospital and evaluate the presence of isolated aortic metastasis. Using a prospectively maintained database, we recorded all cases of endometrioid endometrial cancer that underwent lymph node dissection and determined the rate and location (pelvic or para-aortic) of lymph node metastasis. A total of 212 patients with endometrioid type endometrial cancer were surgically treated at our institution from May 2008 to June 2013. Ninety underwent pelvic and para-aortic lymphadenectomy. Thirteen had positive nodes upon pathological examination. Six (6.6%) of 90 patients had positive para-aortic nodes with negative pelvic nodes. In our series, the incidence of isolated aortic nodal metastasis is high compared with other published reports. Performing aortic lymphadenectomy only in case of positive pelvic nodes would have underdiagnosed 6 (46%) of 13 stage IIIC cancers.

Pelvic sentinel lymph node mapping and aortic nodal status in endometrial cancer: Does infrarenal aortic lymph node metastasis really occur in isolation?

Pelvic sentinel lymph node mapping and aortic nodal status in endometrial cancer: Does infrarenal aortic lymph node metastasis really occur in isolation?

Pelvic sentinel lymph node status and risk of aortic nodal metastasis in patients with endometrial cancer.

5597 Background: Pelvic sentinel lymph node (SLN) mapping is hypothesized to improve the accuracy of surgical staging. The clinical relevance of isolated tumor cell (ITC) metastasis compared to H&E...

Correlation between the extent of intraperitoneal disease and nodal metastasis in node-positive ovarian cancer patients

AimsTo investigate correlations between extent of disease (ED), frequency and location of nodal metastases in node-positive EOC patients. MethodsData were collected from 116 consecutive patients who underwent systematic lymphadenectomy during primary surgery. Patients were grouped in ED1 (disease confined in pelvis), ED2 (disease extended to abdomen), and ED3 (distant metastases). Univariate and multivariate analysis were performed for overall survival and progression-free survival (PFS). ResultsCorrespondence analysis revealed associations between ED1 and negative nodes, ED2 and positive aortic/pelvic nodes, and ED3 and positive external and common iliac nodes. The most representative group for nodal metastases in ED1 was aortic nodes (77.8%). The number of positive pelvic nodes increased with ED; the RR was 0.58 for ED2 and 0.25 for ED3 (p = 0.004). The RR for positive external iliac nodes was 0.66 in ED2 and 0.31 in ED3 (p = 0.002); the RR for positive common iliac nodes was 0.76 and 0.17, respectively (p = 0.001). Multivariate analysis revealed that aortic nodal metastasis was associated with PFS (p = 0.03; HR, 1.95). ConclusionDistribution and percentage of nodal metastases varied with ED. The risk of pelvic nodal metastasis, increased with ED. Location of positive nodes was correlated with PFS.

Late occurrence of an unusual tumour of left native kidney in an allograft recipient.

A 62-year-old diabetic male with end-stage renal disease underwent live renal transplantation in March 2009 with 225 mg of thymoglobulin as induction. In May 2012, evaluation by a computed tomography (CT) scan for recurrent urinary tract infection (UTI) and left loin showed left native kidney neoplasm with para aortic node metastasis (Figure 1). His baseline creatinine was 123.76 μmol/L (1.4 mg/dL). Left radical nephrectomy revealed moderately differentiated squamous cell carcinoma (SCC) on histology. Sirolimus 1 md od was added to his immunosuppressant regime which included cyclosporine A 150 mg bd, prednisolone 5 mg od and mycofenolate mofetil 1 g bd. A positron emission tomography (PET) scan in June 2012 showed residual lesions in the postoperative bed infiltrating left psoas muscle and metastasis to tail of pancreas and penile urethra (Figure 2). Following this, cyclosporine was discontinued. He received radiotherapy for the pancreatic metastasis and underwent excision of the urethral nodule with perineal urethrostomy. In September 2012, a revision of the perineal urethostomy was done to relieve an obstruction of the neo-meatus which had been causing repeated urinary tract infection. The rapamycin trough level was 3.98 nmol/L (4.79 ng/dL), and serum creatinine was 114.92 μmol/L (1.3 mg/dL). The patient continues on radiotherapy and is having stable graft function. Fig. 1. CT scan showing SCC of left native kidney with para-aortic nodes. The allograft is also seen. Fig. 2. PET scan showing increased uptake by the urethral secondary and the urine in the bladder. Primary SCC of native kidney in a renal transplant recipient is very rare, with, to our knowledge, no reported cases in the literature so far. The pathogenesis of SCC is due to chronic irritation superimposed with infection which induces squamous metaplasia leading to leukoplakia and finally neoplasia [1]. This occurs in chronic calculi, analgesic abuse and radiotherapy [2], which was not the case in our patient. A radiological diagnosis of SCC is difficult due to the absence of specific characteristic signs [2], an accurate diagnosis is only possible on postoperative histological analysis or renal fine needle aspiration cytology [1].

Abstract 5713: Significant systemic therapeutic effects of high-LET immunoradiation by 212Pb-Trastuzumab against prostatic tumors of androgen-independent human prostate cancer in mice

Abstract Purpose The purpose of this study was to determine therapeutic effects and systemic toxicity of 212Pb-Trastuzumab in an orthotopic model of human prostate cancer cells in nude mice. Experimental Design TCMC-Trastuzumab was radiolabeled with 212Pb. The activity and integrity of 212Pb-Trastuzumab was confirmed by a competitive binding assay and SDS-PAGE analysis. Therapeutic effects were determined in an orthotopic model of human prostate cancer in nude mice. Body weight, blood cell counts, serum alanine transaminase (ALT), blood urea nitrogen (BUN), and tissue histology were examined to evaluate systemic toxicity of 212Pb-Trastuzumab therapy. Results The 212Pb-Trastuzumab generated from the procedure was intact and had high binding affinity with a dissociation constant (Kd) of 3.9 ± 0.99 nM. PC-3MM2 cells, which expressed relatively a lower level of Her2 both in culture and in tumors, were used in the study. A single injection of 212Pb-Trastuzumab reduced tumor growth by 60-80%, reduced aortic lymph node metastasis, and prolonged the survival of tumor-bearing mice. Treatment with 212Pb-Trastuzumab did not cause significant changes in body weight, serum SGPT and BUN, hematological profiles, and histological morphology of several major organs of tumor-bearing mice. Conclusion The data presented in this report demonstrated that the 212Pb-Trastuzumab therapy did not cause significant systemic toxicity and was very effective in retarding tumor growth and prolonging survival of mice bearing tumors that express very low levels of Her2. These findings suggest that 212Pb-Trastuzumab, used alone or in combination with other means, could be an effective modality for management of advanced human prostate cancer. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5713. doi:1538-7445.AM2012-5713

Location of aortic node metastases in locally advanced cervical cancer

BackgroundTo assess the location of aortic node metastasis in patients with locally advanced cervical cancer undergoing extraperitoneal aortic lymphadenectomy to define the extent of the aortic lymphadenectomy. Material and methodsBetween August 2001 and December 2010, 100 consecutive patients with primary locally advanced cervical cancer underwent extraperitoneal laparoscopic aortic and common iliac lymphadenectomy. The location of aortic node metastases, inframesenteric or infrarenal was noted. ResultsThe mean number±standard deviation (SD) of aortic nodes removed was 15.9±7.8 (range 4–62). The mean number±SD of inframesenteric (including common iliac) nodes removed was 8.8±4.5 (range 2–41) and the mean number±SD of infrarenal nodes removed was 7.8±4.1 (range 2–21). Positive aortic nodes were observed in 16 patients, and in 5 (31.2%) of them the infrarenal nodes were the only nodes involved, with negative inframesenteric nodes. ConclusionInframesenteric aortic nodes are negative in the presence of positive infrarenal nodes in about one third of patients with locally advanced cervical cancer and aortic metastases.

Significant systemic therapeutic effects of high-LET immunoradiation by 212Pb-trastuzumab against prostatic tumors of androgen-independent human prostate cancer in mice

The purpose of this study was to determine therapeutic effects and systemic toxicity of 212Pb-trastuzumab in an orthotopic model of human prostate cancer cells in nude mice. TCMC-Trastuzumab was radiolabeled with 212Pb. The 212Pb-trastuzumab generated from the procedure was intact and had high binding affinity with a dissociation constant (of 3.9±0.99 nM. PC-3MM2 cells, which expressed a lower level of HER2 both in culture and in tumors, were used in therapy studies. A single intravenous injection of 212Pb-trastuzumab reduced tumor growth by 60-80%, reduced aortic lymph node metastasis, and prolonged the survival of tumor-bearing mice. Treatment with 212Pb-trastuzumab did not cause significant changes in body weight, serum glutamic pyruvic transaminase (SGPT), blood urea nitrogen (BUN), hematological profiles, and histological morphology of several major organs of tumor-bearing mice. These findings suggest that a systemic delivery of 212Pb-trastuzumab could be an effective modality for management of advanced human prostate cancer.

Laparoendoscopic Single-Site Extraperitoneal Aortic Lymphadenectomy: First Experience

To report the first clinical experience with laparoendoscopic single-site (LESS) extraperitoneal aortic lymphadenectomy. A 33-year-old woman with biopsy proven locally advanced squamous cell carcinoma of the cervix was taken to the operating room for surgical staging. Preoperative imaging did not detect any aortic lymph node metastases. Informed consent for LESS extraperitoneal aortic lymphadenectomy was obtained. A 2 cm transverse incision was made on the left side midway between the iliac crest and inferior costal margin along the middle axillary line. The preperitoneal space was created and the Triport(TM) inserted. Using the Deflectable-Tip EndoEye(TM) laparoscope and two straight instruments, the aortic lymphadenectomy was performed as defined by the disease-specific oncologic principles. The procedure was completed in 125 minutes. There were no intraoperative or postoperative complications, and the blood loss was minimal (10 mL). The patient was discharged home on postoperative day number 1. LESS extraperitoneal aortic lymphadenectomy yielded 10 lymph nodes. Microscopic metastatic squamous cell carcinoma was detected in 1 out of the 10 lymph nodes. Her treatment plan was modified to extend the field of radiation to include the paraaortic lymphatic basins. LESS extraperitoneal aortic lymphadenectomy is feasible and safe, and provides a comprehensive assessment of aortic lymph nodes as defined by the disease-specific oncologic principles.