Celiac Lymph Research Articles

Efficacy and safety of the combination of tisleizumab with chemoradiotherapy in oligorecurrence esophageal squamous cell carcinoma: A prospective phase II study.

4057 Background: The postoperative recurrence and metastasis rate of esophageal squamous cell carcinoma (ESCC) remains high and prognosis is poor. PD-1 immune checkpoint inhibitors have shown efficacy in targeting advanced esophageal cancer. This phase II study aims to explore the efficacy and safety of concurrent chemoradiotherapy and immunotherapy for ESCC patients with oligometastatic recurrence after radical surgery. Methods: This phase II study enrolled ESCC patients from 3 hospitals in China, diagnosed oligometastatic recurrence after radical surgery. The 1st stage, with 10 patients enrolled, was designed to explore the safety level and the 2nd stage was to explore efficacy. The oligorecurrence is defined as progression occurring three months after the operation with no more than three metastatic regions. The local recurrence was defined as tumor bed or anastomotic recurrence. The regional lymph node recurrences were regarded as mediastinal region and celiac lymph, respectively. The distal recurrences were considered as supraclavicular, retroperitoneal region and other distal organs. All of the positive regional lymph nodes were collectively counted as one lesion if regional lymph node recurrences existed. Tisleizumab was delivered on D1,22. Nab-paclitaxel 150mg/m2 (starting on D2,23) and cisplatin, 75mg/m2(starting on D2-4,22-24) were administered for two cycles. The radiotherapy was delivered with 50.4-60Gy, 1.8-2Gy per fraction. After CRT, patients received Tisleizumab every 3 weeks for 3-6 months and 2-4 cycle consolidation chemotherapy. The primary endpoint was 1-year OS, the second endpoints were 1-year PFS, ORR and toxicities. Results: Between Jan 2021 and May 2023,50 patients were screened for enrolment and 44 patients met the eligibility criteria. The metastatic regions were made up by the local (15.9%),regional (47.7%), distal (13.6%) and mixed recurrence (22.7%). In the 1st stage, one patient had a grade-3 Immune-related erythra out of ten patients. All patients were delivered chemoradiotherapy, 36(81.8%) patients had completed two cycles of immunotherapy. The ORR rate was 84.1%. During concurrent chemoradiotherapy, the incidence of grade≥3 treatment-related adverse events was nausea (9.1%), vomit (4.5%), anorexia (4.5%), leukopenia (13.6%), hepatitis (2.3%), radiation esophagitis (1.4%), erythra (4.5%). There were 5 cases of Immune-related adverse, including 2 cases of erythra, 1 case of hypothyroidism, hepatitis, gastroenteritis, respectively. With the median follow-up time of 19 months (range:4-30 months), 1-year OS and PFS was 83.2% and 79.2%. The median OS and the median PFS were not reached. Conclusions: Concurrent chemoradiotherapy and immunotherapy yielded satisfactory 1-year OS rate and manageable toxicities in oligometastatic recurrence patients with ESCC after radical surgery. Clinical trial information: NCT04821765 .

Solitary Celiac Lymph Node Metastasis Has a Better Long-Term Survival Compared With Solitary Mediastinal Lymph Node Metastasis in Esophagectomy of Esophageal Squamous Cell Cancer: A Propensity Score Matching Analysis.

BackgroundThe prognostic benefit of extensive lymphadenectomy remains controversial in esophageal squamous cell carcinoma (ESCC). The purpose of this retrospective study was to investigate the potential effect of solitary mediastinal (SM) lymph node metastasis and solitary celiac (SC) lymph node metastasis on the short- and long-term outcomes for patients who underwent minimally invasive McKeown esophagectomy.MethodsFrom September 2009 to December 2020, a total of 934 cases were diagnosed with ESCC and underwent minimally invasive McKeown esophagectomy in our department; 223 cases met the inclusion and exclusion criteria. Propensity score matching (PSM) was utilized to contrast the postoperative results and long-term survival of Group 1 (SM) and Group 2 (SC). Univariate and multivariate Cox proportional hazards regression analyses were used on possible predictors of survival.ResultsOne hundred forty-seven patients were available for outcome comparison after PSM. The postoperative results were not significantly different between the two groups. In terms of long-term survival, the 5-year disease-free survival (DFS) was 37.6% and 57.3% (p = 0.191) and 5-year disease-specific survival (DSS) was 39.7% and 68.4% (p = 0.028) for Group 1 (SM) and Group 2 (SC), respectively. Univariate and multivariate Cox proportional hazards regression analyses showed that body mass index (BMI), pathologic stage (pStage), and SC/SM grouping had significant hazard ratios (HRs), which suggested that SC is associated with better DSS.ConclusionThis cohort study showed that SC lymph node metastasis has a better long-term survival compared with SM lymph node metastasis in esophagectomy of ESCC. The results challenge the current understanding and need confirmation in further research.

Application of total mesoesophageal excision combined with sanye lymph node dissection in radical resection of esophageal carcinoma under thoracoscopy and laparoscopy

Objective To evaluate the clinical efficacy of total mesoesophageal excision and sanye lymph node dissection in the radical resection of esophageal carcinoma under thoracoscopy and laparoscopy, and to investigate its safety and feasibility, and to find a more reasonable and effective surgical treatment of esophageal carcinoma. Methods One hundred and twenty-six cases of esophageal cancer who underwent the minimally invasive surgery under thoracoscopy and laparoscopy for esophageal cancer in Central Hospital of Hengyang from October 2015 to September 2017 were retrospectively analyzed.Among them, Sixty-four patients accepted total mesoesophageal excision and sanye lymph node dissection under thoracoscopy and laparoscopy (observation group), Sixty-two cases accepted with conventional esophagectomy under thoracoscopy and laparoscopy (control group). The operation time, blood loss, indwelling time of thoracic drainage tube, postoperative drainage volume, postoperative hospitalization time, number of lymph node dissection, lymph node metastasis degree, perioperative complications of the two groups were analyzed and compared.The number of lymph node dissection and lymph node metastasis degree in different regions were compared between the two groups.The number of recurrence and death were recorded in the two groups. Results Compared with the control group, the operation time was longer in the observation group((264.9±32.9) min vs.(233.5±30.4) min, t=-5.56, P 0.05). The number of lymph nodes in the observation group was significantly higher than that in the control group ((32.7±15.5) pieces vs.(20.9±11.2) pieces, t=-4.93, P 0.05). Left and right recurrent laryngeal nerve, thoracic esophagus, celiac artery lymph node dissection of the number of observation group was higher than that of the control group ((4.7±3.2) pieces vs.(1.5±1.4) pieces, t=-7.25; (6.0±2.7) pieces vs.(3.1±1.7) pieces, t=-7.12; (5.7±2.4) pieces vs.(3.2±1.9) pieces, t=-6.48; P 0.05). There were no deaths in the two groups. Conclusion Total mesoesophageal excision and three-field lymph node dissection in radical resection of esophageal carcinoma under thoracoscopy and laparoscopy is safe and feasible, the recent effect does not increase the surgical complications, but its long-term effect need a lot of long-term follow-up.A relatively thorough cleaning of the esophageal mesentery and its lymph nodes can minimize the tumor in the subendothelial micrometastasis, and is beneficial for the prognosis of patients with esophageal cancer. Key words: Esophageal carcinoma; Esophageal mesentery; Sanye lymph node dissection; Thoracoscopy and laparoscopy; Micrometastasis

Lymph node metastasis in gastric cancer: Location of positive station to predict survival after preoperative therapy.

166 Background: We sought to determine the association between the identification of positive lymph nodes on D2 lymph node dissection (LND) with stage and outcomes, in the era of preoperative treatment for gastric cancer. Methods: We reviewed data from a prospectively maintained database of gastric cancer patients who underwent resection of gastric or gastroesophageal cancer at our institution from 2005-2016. Central lymph nodes (CnLN) were defined as common hepatic, celiac, and proximal splenic artery lymph nodes (stations #8, 9, and 11p). Risk factors for CnLN metastases, and overall survival (OS) were examined. Results: We identified 356 patients, median age was 64 years (IQR 54-71) and 59% were male. Preoperative therapy was given in 66% of patients. D2 LND was performed in 80% of patients, and the median number of LN examined was 25 (IQR 18-34). Most patients (N = 244, 68%) had separately-examined CnLN in pathology and the median number of examined LNs was higher in this group (27 vs 19; p < 0.001). The CnLN positivity rate was 9.1% (22/244; #8: 4.8%, #9: 6.1%, and #11p: 4.8%), which was higher in advanced pT stage patients (pT0 - 3%, pT1 - 0%, pT2 - 6%, pT3 - 18%, pT4 - 13%; p = 0.001). If we assume that D2 LND was not performed on these patients, a total of 7 (3%, 7/244) patients would have had pN stage down-migration (6 with N1 to N0, 1 with N2 to N1). Of the 22 CnLN-positive patients, 10 (45%) had pN1, 2 (9%) had pN2, and 10 (45%) had pN3 stages. On multivariate analysis, EUS N stage (positive) was associated with positive CnLNs (OR 2.86 [95%CI 1.08-7.58]). Among 342 patients who had R0 resection, the median follow-up was 3.6 years, and the median OS was 11.6 years. Among patients who received preoperative therapy, pT3/4 stage (HR 2.44 [1.27-4.69]; p = 0.01) and positive CnLN (HR 5.44 [2.36-12.52]; p < 0.001) were negatively associated with OS by multivariate analysis. Conclusions: CnLN metastases are uncommon in gastric cancer, and are associated with an adverse impact on OS. However, long-term survival is still possible in patients with positive CnLN whom underwent a D2 lymph node dissection. Larger multi-institutional studies are needed to determine if CnLN positivity requires a separate staging category.

Exploration under the dome: Esophageal ultrasound with the ultrasound bronchoscope is indispensible.

Background:Effective use of the convex curvilinear ultrasound bronchoscope in the esophagus (EUS-B) for fine needle aspiration biopsy of mediastinal structures is now well described. In contrast, there is little to no reporting, depending on the site of EUS-B for access to sub-diaphragmatic structures. Our practice has been accessing sub-diaphragmatic sites for years. This review documents our experience with EUS-B to biopsy liver, left adrenal glands, and coeliac lymph nodes.Methods:After Institutional Review Board's approval, all endosonographic procedures performed by interventional pulmonary between July 2013 and June 2015 were reviewed. Those including biopsy of sub-diaphragmatic sites were then selected for analysis.Results:Over the study interval, 45 sub-diaphragmatic biopsy procedures (25 left adrenal glands, 7 liver, and 13 celiac node) were performed with EUS-B. In all cases, cellular adequacy was present, and samples were large enough for immunohistochemistry and any relevant ancillary studies. Metastatic malignancy was documented in 58% of cases, 16% of cases contained benign diagnostic findings, and in 27% of cases, normal organ tissue was documented. There were no complications.Conclusions:Operators comfortable with the endobronchial ultrasound scope in both the airway and the esophagus can actively seek and successfully perform biopsy of sub-diaphragmatic abnormalities when present and can thereby add to the diagnostic value of the procedure.

Novel celiac artery lymph node dissection path in gastric cancer of stage III C

Pathological types of gastric cancer in stage Ⅲ C include T4a-SEN3,T4b-SIN2,T4b-SIN3.Celiac artery metastatic lymphadenopathy fused into blocks,usually from bottom to top.Limited operation space revealed anatomical and pathological factors,the dissection of the celiac artery lymph nodes,processing the left gastric artery root difficulty.Application of novel celiac artery lymph nodes dissection path,avoiding the limitation of the celiac artery lymph node dissection space exposure factors,so that the dissection of the celiac artery lymph nodes is more complete,processing the left gastric artery root easily,reduce the amount of bleeding,shorten operation time,increase the average lymph node dissection and the Ⅲ C gastric cancer resection rate. Key words: Gastric neoplasms ; Novel path ; Lymph nodes dissection; Celiac artery and its branches

Analysis of Metastasis of Thoracic Mediastinal Lymph Nodes in 63 Patients with Cardiac Cancer

Objective To study the status of thoracic mediastinal lymph nodes metastasis in patients with cardiac cancer.Methods The data of lymph nodes from 63 patients with cardiac cancer and lymph nodes resection from June,2008 to October,2009 were prospectively analyzed.Results The rate of metastasis of lymph nodes was 20.63% in thoracic cavity and 66.67% in celiac cavity,respectively.Thoracic mediastinal lymph nodes metastases correlated to tumor diameter,depth of tumor invasion,lower esophagus with tumor invasion and celiac lymph nodes.Multivariate Logistic Regression Analysis showed lower esophagus of tumor invasion was the most important influencing factors.Conclusion This study showed that the lymph node metastasis of cardiac cancer tended towards celiac and thoracic cavity,both thoracic and celiac systemic lymphadenectomy are necessary.

Intervention d’Appleby : place et technique en cas d’envahissement tumoral du tronc cœliaque et de ses branches

Cancerous invasion of the celiac trunk is usually considered a contraindication to attempts at curative resection. Appleby was the first to propose an en bloc resection of the celiac trunk along with the celiac nervous plexus and lymph nodes for advanced gastric cancer. We describe a "modified Appleby technique" without gastrectomy for locally advanced cancer of the body of the pancreas. It accomplishes radical tumor resection, relieves pain, and improves the quality of life and overall prognosis. The principal complications are pancreatic fistula and gastric ischemia. Preoperative embolization of the common hepatic artery helps to develop favorable collateral blood flow and to avoid ischemia of the hepatobiliary system. A stomach-preserving" Appleby resection" may be appropriate treatment for selected nonaggressive cancers of the midpancreas; preoperative embolization of the common hepatic artery is an important adjunct of this technique.

Celiac and Perigastric Lymph Node Metastasis of Prostate Cancer Diagnosed with Endoscopic Ultrasound-Guided Fine-Needle Aspiration

Endoscopic ultrasound has been used to diagnose and stage gastrointestinal and nongastrointestinal tumours. To our knowledge, the present report describes the first case of celiac and perigastric lymph node metastasis of prostate cancer diagnosed with endoscopic ultrasound-guided fine-needle aspiration.

22-jährige Frau mit Fieber, Nachtschweiß, Gewichtsverlust und Hepatomegalie

A 22 year old female patient presented with fever, night sweats, weight loss and hepatomegaly associated with elevated inflammatory parameters and liver enzymes. Computer tomography revealed a mass located between the inferior vena cava and the psoas muscle as well as enlarged celiac, retroperitoneal and retrocaval lymph nodes. Biopsies of the retrocaval mass led to the diagnosis of retroperitoneal fibrosis. Within a few days of treatment with corticosteroids clinical presentation improved and imaging studies detected complete regression of the retrocaval mass after 6 months.

Chirurgie des Ösophaguskarzinoms - Qualitätssicherung

Oesophageal cancer is the sixth most common malignancy worldwide and represents 4 % of newly diagnosed cancers. 5-year survival probability is given between 8 to 20 %. Within North America and Europe, the incidence of adenocarcinoma rose 100 % in the 1990s; strongly correlated with reflux and Barrett's metaplasia. DIAGNOSIS: Because of the elasticity of the esophagus, usually two thirds of the lumen is obstructed before dysphagia occurs. Because dysphagia is the leading complaint in 80 to 90 % of patients with esophageal carcinoma, any adult who complains of dysphagia warrants esophagoscopy and biopsy to rule out carcinoma. Further obligatory examinations include CT of chest and abdomen to assess distant metastases (M 1) including the celiac trunk and cervical lymph nodes. Endoscopic ultrasound (EUS) is applied for proper assessing the depth of tumor invasion, length of tumor regional nodal disease, and involvement of adjacent structures. The power of the PET-CT for evaluation of distant metastases complementary or as an alternative for CT is not yet clear. THERAPY: Treatment includes surgery, chemotherapy, radiation, or a combination of these techniques. Therapy for esophageal carcinoma is influenced by the knowledge that alocal tumor invasion or distant metastatic disease often precludes cure. Palliation is appropriate when the general condition of the patients prohibits resection or in case both technical or prognostic irresectability due to extensive invasion of vital structures or due to distant metastases. However, 50 % of the patients with oesophageal carcinoma at the time of their presentation are eligible for curative treatment. In order to minimize the risk of endoluminal recurrence, a safe margin of 6- to 8-cm of normal esophagus has to be removed. Concerning the surgical approach, the extent of the lymphadenectomy and the level of the anastomosis, several techniques of oesophagectomy exist. - According to the surgical approach transhiatal, thoracoabdominal and cervicoabdominal approaches are differentiated. - Depending from the approach there are also different levels of lymphadenectomy: One-Field-Lymphadenectomy (only blunt dissection), two-field-lymphadenectomy (En-Bloc-Oesophagectomy) and three-field-lymphadenectomy (En-Bloc-Oesophagectomy + neck dissection). - Concerning the site of anastomosis, collar vs. intrathoracic anastomosis are distinguished.

Intra-abdominal follicular dendritic cell sarcoma

Follicular dendritic cell (FDC) sarcoma is a very rare condition. We report here an intra-abdominal FDC sarcoma occurring as a mass, dependent on the celiac and left gastric lymph chains, that was completely excised. Eighteen months after surgery a recurrence at the liver pedicle was detected by a CT-scan and fully resected; in order to prevent another disease relapse postoperative radiotherapy was given.

Duodenopancreatectomía cefálica con reconstrucción venosa portomesentérica. Aspectos técnicos

Cephalic pancreaticoduodenectomy (CPD) with mesentericoportal venous resection increases the resectability rate of pancreatic tumors. When performed in selected patients and by experienced surgical teams, this technique shows the same long-term rates of morbidity, mortality and survival as CPD without vascular resection, provided that negative surgical margins are obtained. This procedure is contraindicated by complete thrombosis of the portal or superior mesenteric veins, invasion of the superior mesenteric artery or celiac trunk, and distant or periaortic lymph node involvement. Venous reconstruction can be performed through lateral suture, termino-terminal anastomosis, or by graft placement. We believe that intercalation of the autologous internal jugular vein facilitates resection and minimizes phenomena of venous stasis. We present a case of adenocarcinoma of the pancreatic head infiltrating the superior mesenteric-portal vein confluence that underwent surgery in our hospital. CPD with mesentericoportal venous resection and reconstruction using autologous internal jugular vein were performed. The most important technical features are discussed.

Comparison of Accuracy of the Positron Emission Tomography, Computed Tomography, and Endoscopic Ultrasonography for Detection of the Metastases at Celiac Axis Lymph Nodes in Lung Carcinoma: A Prospective Study

Comparison of Accuracy of the Positron Emission Tomography, Computed Tomography, and Endoscopic Ultrasonography for Detection of the Metastases at Celiac Axis Lymph Nodes in Lung Carcinoma: A Prospective Study Pankaj Singh, Rahul Gupta, Yashodeep Jadhav, Rama M. Reddy, Phalguni Mukhopadhyay, Rajnikanth S. Shah, Chetan Jinadatha, John C. Lasiter, Ashish Sharma, Richard A. Erickson Background: Previous studies using CT scan for staging Non-small cell lung cancer (NSCLC) have not reported celiac axis (CA) as a site for distant metastases. Detection of metastases to CA is critical since these patients are considered nonresectable. EUS is considered superior to CT scan for detection of CA lymphadenopathy. Aim: To determine the incidence of metastases to lymph nodes at CA in patients with lung carcinoma using EUS-FNA. Methods: Consecutive subjects with CT findings of newly detected lung mass were prospectively enrolled for EUS-FNA. FNA was performed whenever lymph node could be identified irrespective of the endosonographic features. Primary outcome was to determine the sensitivity of the EUS-FNA, CTscan and PETscan for detection of the metastases to lymph nodes at celiac axis. Gold standard for the diagnosis of metastases was cytologically positive malignant cells. Results: 53 consecutive cases of lung carcinoma were identified that underwent EUS evaluation of the celiac axis. EUS identified lymph nodes at CA in 11 of the 53 cases. EUS-FNA was performed in all the 11 cases. EUS-FNA cytologically confirmed malignancy in 9 of the 11 cases. CT scan and PET scan missed celiac lymphadenopathy in 4 of 9 cases and 2 of 5 cases, respectively. EUS influenced the management in 4 of the 9 cases. In two patients EUS avoided surgery by detection of the metastases at CA that were missed by CT scan and PET scan. In one patient with lung carcinoma and past history of lymphoma, EUS-FNA confirmed the enlarged lymph node to be metastastic lung carcinoma and not the recurrence of lymphoma and in one case immunocytochemisty of the cytology showed that celiac metastases is from non-lung primary. Conclusion: CA is an important site for distant metastasis in NSCLC. EUS-FNA detects metastasis at CA that is missed by both CT and PET scan. Of all the diagnostic tests, EUS-FNA is the only test that cytologically confirms the metastases and influences the management.

A retrospective analysis to identify variables predictive of achieving a pCR after neoadjuvant chemoradiation therapy for locally advanced esophageal cancer

4061 Background: Patients achieving a complete pathological response (pCR) after neoadjuvant chemoradiation therapy (CRTx) for locally advanced esophageal cancer have a superior prognosis as compared to those who do not achieve a pCR. A retrospective, institutional review was conducted to identify variables potentially predictive of achieving a pCR. Methods: From 1992 through 2002, 86 patients with esophageal cancer were identified who met criteria for review including pretreatment transesophageal ultrasound (EUS) stage ≥ II and platinum-based CRTx followed by transthoracic esophagectomy including complete staging with celiac and mediastinal lymph node dissections. The cohort was mainly male (88.2%, n=75) with a mean age of 57.8 yrs and adenocarcinoma as the predominant histology (89.4%, n=76). Fifty-five (65.8%) patients demonstrated EUS stages III or IVa prior to CRTx. Results: Twenty-five (29.4%) patients demonstrated a pCR after CRTx. Although none of the 10 variables analyzed were significantly predi...

Influence of celiac axis lymph nodes in the definitive treatment of esophageal cancer.

The management of patients with cancer of the distal thoracic esophagus is often made difficult by the presence of disease in the celiac axis lymph nodes. We investigated the outcome of such patients treated for cure in an attempt to better define the best treatment. The charts of all patients with esophageal cancer treated at the Department of Radiation Oncology at the Medical University of South Carolina between 1990 and 1998 were reviewed. Three groups of patients were analyzed: NoMo, N1Mo, and patients with positive celiac axis lymph nodes (M1a). Among 217 patients, 56 patients received radiotherapy with intent to cure, along with surgery, chemotherapy, or some combination of these modalities. Of these, 14 had disease of the distal esophagus with the celiac axis as their only site of distant disease. Comparison of survival curves in the three analyzed groups revealed no statistically significant differences in terms of overall survival (p = 0.3458 by the log-rank test) or disease-free survival (p = 0.5509 by the log-rank test). Patients with positive celiac axis lymph nodes as their only site of "M1" disease experienced a 2-year survival rate similar to "Mo" patients when treated with curative intent.

Immunobiology of liver dendritic cells.

Dendritic cells (DC) are rare, bone marrow-derived antigen-presenting cells that play a critical role in the induction and regulation of immune reactivity. In this article, we review the identification and characterization of liver DC, their ontogenic development, in vivo mobilization and population dynamics. In addition, we discuss the functions of DC isolated from liver tissue or celiac lymph, or propagated in vitro from liver-resident haemopoietic stem/progenitor cells. Evidence concerning the role of DC in viral hepatitis, liver tumours, autoimmune liver diseases, granulomatous inflammation and the outcome of liver transplantation is also discussed.