Complete Node Dissection Research Articles

Lymphovenous Bypass for Immediate Lymphatic Reconstruction in Breast Cancer Patients Undergoing Axillary Lymph Node Dissection: Minimizing the Risk of Upper Extremity Lymphedema.

Studies have shown a significant reduction in breast cancer-related lymphedema (BCRL) rates in patients undergoing complete axillary lymph node dissection (cALND) combined with immediate lymphatic reconstruction (ILR) using lymphovenous bypass (LVB).The purpose of this study was to determine if ILR with LVB at the time of cALND results in a decreased incidence of BCRL and its impact on patient quality of life (QOL). In this prospective cohort study, patients ≥ 18 years requiring cALND underwent ILR from 2019 to 2021. The primary outcome was bilateral upper limb volumes measured by Brørson's truncated cone formula and the Pero-System (3D Körper Scanner). The secondary outcome was QOL measured by the Lymphedema Quality of Life (LYMQOL) arm patient-reported outcome measurement. Forty-two patients consented to ILR using LVB. ILR was completed in 41 patients with a mean of 1.9 ± 0.9 lymphovenous anastomosis performed. Mean age of patients was 52.4 ± 10.5 years with a mean body mass index of 27.5 ± 4.9 kg/m2. All patients (n = 39, 100%) received adjuvant therapy after ILR. Mean follow-up was 15.2 ± 5.1 months. Five patients met criteria for lymphedema throughout the duration of the study (12.8%), with two patients having resolution, with an overall incidence of 7.7% by the end of the study period. Patients with lymphedema were found to have statistically significant lower total LYMQOL values at 18 months (8.44 ± 1.17 vs. 3.23 ± 0.56, p < 0.001). A mean increase of 0.73 ± 3.5 points was observed for overall QOL average for upper limb function at 18 months compared with 3 months (t = 0.823, p = 0.425). This study showed an incidence of 7.7% lymphedema development throughout the duration of study. We also showed that ILR has the potential to reduce the significant long-term adverse outcomes of lymphedema and improve QOL for patients undergoing cALND.

Lymphadenectomy After Melanoma-A National Analysis of Recurrence Rates and Risk of Lymphedema.

Treatment for melanoma after a positive sentinel lymph node biopsy includes nodal observation or lymphadenectomy. Important considerations for management, however, involve balancing the risk of recurrence and the risk of lymphedema after lymphadenectomy. From the Merative MarketScan Research Databases, adult patients were queried from 2007 to 2021. International Classification of Disease, Ninth (ICD-9) and Tenth (ICD-10) Editions, diagnosis codes and Current Procedural Terminology codes were used to identify patients with melanoma diagnoses who underwent an index melanoma excision with a positive sentinel lymph node biopsy (SLNB). Main outcomes were completion lymph node dissection (CLND) utilization after a positive SLNB, developing lymphedema with or without CLND, and nodal basin recurrence 3 months or more after index excision. Subanalyses stratified by index excision year (2007-2017 and 2018-2021) and propensity score matched were additionally conducted. Demographics and comorbidities (measured by Elixhauser index) were recorded. A total of 153,085,453 patients were identified. Of those, 359,298 had a diagnosis of melanoma, and 202,456 patients underwent an excision procedure. The study cohort comprised 3717 patients with a melanoma diagnosis who underwent an excision procedure and had a positive SLNB. The mean age of the study cohort was 49 years, 57% were male, 41% were geographically located in the South, and 24% had an Elixhauser index of 4+. Among the 350 patients who did not undergo CLND, 10% experienced recurrence and 22% developed lymphedema. A total of 3367 patients underwent CLND, of which 8% experienced recurrence and 20% developed lymphedema. Completion lymph node dissection did not significantly affect risk of recurrence [odds ratio (OR), 1.370, P = 0.090] or lymphedema (OR, 1.114, P = 0.438). After stratification and propensity score matching, odds of experiencing lymphedema (OR, 1.604, P = 0.058) and recurrence (OR, 1.825, P = 0.058) after CLND were not significantly affected. Rates of CLND had significantly decreased (P < 0.001) overtime, without change in recurrence rate (P = 0.063). Electing for nodal observation does not increase the risk of recurrence or reduce risk of lymphedema. Just as CLND does not confer survival benefit, its decreased utilization has not increased recurrence rate.

Safety and quality of cystectomy and pelvic lymph node dissection after neoadjuvant durvalumab and cisplatin/gemcitabine.

To report on the surgical safety and quality of pelvic lymph node dissection (PLND) in patients treated with radical cystectomy (RC) and PLND for muscle-invasive bladder cancer (MIBC) after neoadjuvant chemo-immunotherapy. The Swiss Group for Clinical Cancer Research (SAKK) 06/17 was an open-label single-arm phase II trial including 61 cisplatin-fit patients with clinical stage (c)T2-T4a cN0-1 operable urothelial MIBC or upper urinary tract cancer. Patients received neoadjuvant cisplatin/gemcitabine and durvalumab followed by surgery. Prospective quality assessment of surgeries was performed via central review of intraoperative photographs. Postoperative complications were assessed using the Clavien-Dindo Classification. Data were analysed descriptively. A total of 50 patients received RC and PLND. All patients received neoadjuvant chemo-immunotherapy. The median (interquartile range) number of lymph nodes removed was 29 (23-38). No intraoperative complications were registered. Grade ≥III postoperative complications were reported in 12 patients (24%). Complete nodal dissection (100%) was performed at the level of the obturator fossa (bilaterally) and of the left external iliac region; in 49 patients (98%) at the internal iliac region and at the right external iliac region; in 39 (78%) and 38 (76%) patients at the right and left presacral level, respectively. This study supports the surgical safety of RC and PLND following neoadjuvant chemo-immunotherapy in patients with MIBC. The extent and completeness of protocol-defined PLND varies between patients, highlighting the need to communicate and monitor the surgical template.

Regional lymph node evaluation in pediatric conventional melanoma subtype: a single-center 10-year review

PurposeTo assess the prognostic and therapeutic significance of sentinel lymph node biopsy (SLNB) and completion lymph node dissection (CLND) in pediatric conventional melanoma (CM), while evaluating potential predictive factors for outcomes.MethodsWe conducted a retrospective analysis of medical records spanning 2009–2020, focusing on patients aged 18 or younger with localized cutaneous conventional melanoma.ResultsAmong the 33 patients, SLNB detected metastasis in 57.6% of cases, with 52.6% undergoing CLND. Positive SLN patients had higher relapse risk (HR 5.92; 95% CI 1.27–27.7; P = 0.024) but similar overall survival (HR 3.19; 95% CI 0.31–33.1, P = 0.33).No significant differences in disease-free survival (DFS) and OS were found between patients who underwent CLND and those who did not (HR 1.91; 95% CI 0.49–7.43, P = 0.35, and HR 0.52; 95% CI 0.03–8.32, P = 0.64, respectively). Univariate analysis showed age at diagnosis (P = 0.02) correlated with higher recurrence risk, with a 21% hazard increase per additional year of age.ConclusionsPositive SLN status and age at diagnosis were associated with worse DFS in CM patients. Our study did not find any prognostic or therapeutic value in CLND for pediatric melanoma. Further multicenter trials are needed to confirm our single-institution experience.Level of evidenceLevel IV.

Complete lymph node dissection in cutaneous melanoma patients with positive sentinel lymph node: Outcome and predictors in a retrospective cohort study over 16 years

BackgroundIn melanoma treatment, complete lymph node dissection (CLND) has been considered the therapeutic gold standard in patients with positive sentinel lymph node biopsy (SLNB). This long-held approach was revised in 2017, with recent evidence questioning the therapeutic benefit of CLND in malignant melanoma (MM) therapy. In this study, we aimed to fill this knowledge gap by retrospectively analyzing the impact of CLND on MM patients’ survival. Methods: We retrospectively analyzed the multi-center population-based Clinical Cancer Registry at the Tumor Center Regensburg (TUDOK) database (2004–2020) to identify patients who had been diagnosed with SLN-positive MM and underwent (non)invasive management thereof. Patient cohorts were subdivided according to the treatment received (CLND and waiving CLND). Primary outcomes included overall survival (OS), recurrence-free survival (RFS), and cumulative recurrence rate. Results: We identified 1143 MM patients, of whom 126 (11.0%) had positive SLN status. CLND was waived in the majority of SLN-positive MM cases (n = 71; 56.3%), with 55 (43.7%) patients undergoing CLND. Univariable and multivariable Cox regression revealed no significant advantage for CLND patients compared to non-CLND patients in OS (HR=0.970, p = 0.915 and HR=1.295, p = 0.479, respectively), RFS (HR=1.050, p = 0.849 and HR=1.220, p = 0.544, respectively), and cumulative recurrence rate (HR=1.234, p = 0.441 and HR=1.220, p = 0.544), respectively). Conclusion: We found that CLND had no significant impact on patient survival and MM recurrence rate, thus corroborating the validity of current clinical guidelines.

Complete anatomic segmentectomy shows improved oncologic outcomes compared to incomplete anatomic segmentectomy.

To compare oncologic outcomes after segmentectomy with division of segmental bronchus, artery and vein (complete anatomic segmentectomy) versus segmentectomy with division of <3 segmental structures (incomplete anatomic segmentectomy). We conducted a single-centre, retrospective analysis of patients undergoing segmentectomy from March 2005 to May 2020. Operative reports were audited to classify procedures as complete or incomplete anatomic segmentectomy. Patients who underwent neoadjuvant therapy or pulmonary resection beyond indicated segments were excluded. Survival was estimated with Kaplan-Meier models and compared using log-rank tests. Cox proportional hazards models were used to estimate hazard ratios (HRs) for death. Cumulative incidence functions for loco-regional recurrence were compared with Gray's test, with death considered a competing event. Cox and Fine-Gray models were used to estimate cause-specific and subdistribution HRs, respectively, for loco-regional recurrence. Of 390 cases, 266 (68.2%) were complete and 124 were incomplete anatomic segmentectomy. Demographics, pulmonary function, tumour size, stage and perioperative outcomes did not significantly differ between groups. Surgical margins were negative in all but 1 case. Complete anatomic segmentectomy was associated with improved lymph node dissection (5 vs 2 median nodes sampled; P < 0.001). Multivariable analysis revealed reduced incidence of loco-regional recurrence (cause-specific HR = 0.42; 95% confidence interval 0.22-0.80; subdistribution HR = 0.43; 95% confidence interval 0.23-0.81), and non-significant improvement in overall survival (HR = 0.66; 95% confidence interval: 0.43-1.00) after complete versus incomplete anatomic segmentectomy. This single-centre experience suggests complete anatomic segmentectomy provides superior loco-regional control and may improve survival relative to incomplete anatomic segmentectomy. We recommend surgeons perform complete anatomic segmentectomy and lymph node dissection whenever possible.

A commentary on "Does the time interval between sentinel lymph node biopsy and completion lymph node dissection affect outcome in malignant melanoma? A retrospective cohort study" - correspondence.

A commentary on "Does the time interval between sentinel lymph node biopsy and completion lymph node dissection affect outcome in malignant melanoma? A retrospective cohort study" - correspondence.

Reevaluating Axillary Lymph Node Dissection in Total Mastectomy for Low Axillary Burden Breast Cancer: Insights from a Meta-Analysis including the SINODAR-ONE Trial.

Complete axillary lymph node dissection (cALND) was previously the standard of care for breast cancer (BC) patients with axillary node disease or macro-metastases found via sentinel lymph node biopsy (SLNB). However, due to significant morbidity, contemporary management now considers a more selective approach, influenced by studies like ACOSOG Z0011. This trial showed that cALND could be omitted without compromising local control or survival in patients with low axillary nodal disease burden undergoing breast-conserving therapy, radiotherapy, and systemic therapy. The relevance of this approach for women with low axillary nodal burden undergoing total mastectomy (TM) remained unclear. A PubMed search up to September 2023 identified 147 relevant studies, with 6 meeting the inclusion criteria, involving 4184 patients with BC and low-volume axillary disease (1-3 positive lymph nodes) undergoing TM. Postmastectomy radiotherapy receipt was similar in both groups. After a mean 7.2-year follow-up, both the pooled results and the meta-analysis revealed no significant differences in overall survival. The combined analysis of the published studies, including the subgroup analysis of the SINODAR-One trial, indicates no survival advantage for cALND over SLNB in T1-T2 breast cancer patients with 1-3 positive sentinel lymph nodes (pN1) undergoing mastectomy. This suggests that, following a multidisciplinary evaluation, cALND can be safely omitted. However, the impact of other patient, tumor, and treatment factors on survival requires consideration and therefore further prospective trials are needed for conclusive validation.

Impact of extra-nodal extension and AJCC lymph node staging in predicting recurrence following lymphadenectomy in patients with melanoma

BackgroundRegional lymphadenectomy (RL) has traditionally been recommended in patients with melanoma found to have clinical lymphadenopathy or a positive sentinel lymph node biopsy (SLNB). Regional control of disease is still a relevant issue for patients, even after undergoing lymphadenectomy. The goal of this study was to identify the clinicopathologic characteristics that predict locoregional recurrence in patients who have undergone either therapeutic lymph node dissection (TLND) or completion lymph node dissection (CLND) following SLNB. MethodsRetrospective review of population-based cohort of patients with melanoma lymph node metastasis from the years 2005–2015. Multivariate, proportional hazards regression analysis was performed to determine factors predicting nodal recurrence. Results586 patients underwent a RL, with a median follow up of 35 months. Overall, in-basin recurrence rates in the axilla, groin, and head/neck were 7.7 ​%, 8.7 ​% and 9.2 ​%, respectively. Higher unadjusted recurrence rates occurred following CLND than TLND of the groin (12.8 ​% vs 4.5 ​%) and neck (10.0 ​% vs 4.7 ​%) but not the axilla (7.5 ​% vs 8.0 ​%). Upon multivariate analysis, ENE (HR 2.77; p=<0.0001) and the AJCC lymph node stage (N3 vs N1) (HR 2.51; p ​= ​0.025) were predictive of regional recurrence. ConclusionThe AJCC nodal stage and the presence of extranodal extension were the only variables impacting regional recurrence following regional lymphadenectomy for melanoma. When considering regional disease control, they should be factored into treatment decisions, and surveillance strategies.

SENTINEL LYMPH NODE BIOPSY IN THE MANAGEMENT OF PATIENTS WITH MALIGNANT MELANOMA

Objectives: To evaluate the efficacy of sentinel lymph node biopsy in the treatment of malignant melanoma. Materials and Methods: Thirty-two melanoma patients without distant or clinical lymph node metastasis underwent preoperative lymphoscintigraphy using Tc99m and a handheld gamma probe to identify sentinel lymph nodes for biopsy. In cases with detected sentinel lymph node metastasis, the patient may require total complete lymph node dissection, combined with optional systemic therapy. Follow-up was performed to evaluate the efficacy of this procedure. Results: In 32 melanoma patients, the most common site of primary tumors was the extremity, accounting for 90.6%, with a mean Breslow index (thickness of the primary tumor) of 1.84 mm. The incidence of microscopic lymph node metastasis was 34.4%. For cases with no detected sentinel lymph node metastasis, 100% of patients had a stable condition, and no recurrence or metastasis was detected. In 11 cases with occult nodal metastasis: 2 deaths, 4 patients were treated with chemotherapy, and 5 cases without chemotherapy. The mean duration of hospitalization for the group with sentinel lymph node metastasis was greater than that of the group without sentinel lymph node metastasis, 25.1 ± 3.1 days and 13.5 ± 1.3 days, respectively. Conclusion: Our results suggest that sentinel lymph node biopsy is a less invasive technique for melanoma patients with no clinically detectable lymph node and distant metastases. This procedure has shown initial outcomes, but it is necessary to conduct a study with a larger sample size and a longer follow-up time, as well as comparing it with a control group for accurate evaluation. Received 23 June 2023Revised 22 September 2023Accepted 27 November 2023

Sentinel Node Biopsy Positivity: Is Axillary Dissection Always Necessary? – A Retrospective Analysis

Breast cancer remains a significant health concern, with predictions indicating a rise in global incidence. While the primary focus is on oncological radicality, the aesthetic and psychological impacts of surgical interventions, such as radical mastectomy, cannot be ignored. This study, conducted over 8 years, aimed to identify factors that can prevent unnecessary lymphadenectomy. The research analyzed various parameters, including age, BMI, tumor size, and immunohistochemistry, to determine their correlation with axillary lymph node invasion. The results highlighted the importance of tumor size and estrogen receptor status in predicting axillary lymph node metastasis. The study underscores the value of sentinel lymph node biopsy in early breast cancer treatment, emphasizing its benefits over complete axillary lymph node dissection.

Preventive axillary lymphovenous anastomoses simultaneously with lymph node dissection in the treatment of breast cancer for prevention of lymphedema of the upper limb (LYMPHA technique)

To analyze the effect the LYMPHA technique on the incidence of upper limb lymphedema in patients with breast cancer after complete axillary lymph node dissection. There were 89 patients with breast cancer and signs of metastatic lesion of axillary lymph nodes who underwent complete axillary lymph dissection. In group 1 (41 patients), the LYMPHA technique was used simultaneously with lymph node dissection; in group 2 (48 patients) - lymph node dissection alone. The follow-up period was 1 year. The LYMPHA technique prolonged surgery and decreased duration of postoperative lymphorrhea. The incidence of upper limb lymphedema was 9.8% and 22.9%, respectively. The LYMPHA technique was effective for prevention of upper limb lymphedema after complete axillary lymph node dissection in the treatment of breast cancer.

Prognostic value of the number of biopsied sentinel lymph nodes for Chinese patients with melanoma: A single-center retrospective study.

Sentinel lymph node biopsy (SLNB) helps to determine accurate pathological stages and facilitates strategies for regional disease control in melanoma. However, whether the number of biopsied sentinel lymph nodes (SLNs) influences the patients' survival is rarely investigated. Acral or cutaneous melanoma patients with no history of nodal disease who received SLNB in Fudan University Shanghai Cancer Center (FUSCC) from January 1, 2017, to December 31, 2021 were retrospectively enrolled. Clinicopathological variables including Breslow index, ulceration, number of positive SLNs, SLN/non-SLN status were analyzed. The pathologic nodal (pN) stage and pathological stage were defined. A total of 381 eligible patients were enrolled in this study, of whom 132 (34.7%) patients were diagnosed with SLN-positive. The median number of biopsied SLNs was 2 (range: 1 to 20). Different numbers of biopsied SLNs did not influence the release-free survival (RFS) of the general patients. However, patients with >2 SLNs had a longer RFS than those with 1-2 SLNs in T4, N1a group and those who rejected complete lymph node dissection (CLND). In patients with T4 melanomas, N1a melanomas and those that did not undergo a CLND, the prognosis of those with three or more SLNs retrieved seemed to be improved.

The Role of Lymph Node Dissection in the Management of Upper Urothelial Cancer: A Nodal Status-Based Meta-Analytical Study.

This systematic review was performed to study the prognostic value of lymph node dissection (LND) during nephroureterectomy in upper tract urothelial cancer (UTUC). Five databases were searched on September 11, 2022, to include studies that compared whether LND was performed, the extent of dissection (complete vs. incomplete), and the nodal status (positive "pN+" vs. negative "pN0"). Outcomes included prognosis (overall survival "OS," cancer-specific survival "CSS," disease-free survival "DFS," and recurrence-free survival "RFS") and complications. High-grade complications (≥ grade 3 according to the Clavien-Dindo classification). Data analysis were conducted through STATA. The pooled data are reported log odds ratio (logOR) with 95% CI. Thirty-three studies were analyzed. The LND resulted in improved 5-year OS [logOR=0.10; 95% CI: 0.06-0.15], 5-year CSS [logOR=0.10; 95% CI: 0.04- 0.17], and 10-year CSS [logOR=0.14; 95% CI: 0.06-0.21] when compared to non-LND. However, LND was associated with greater risk of high-grade complications [logOR=0.62; 95% CI: 0.26-0.98]. Complete LND was associated with lower risk of cancer-specific mortality than incomplete LND [logOR=-0.69; 95% CI: -1.22--0.16]. The pN0 patients had better 5-year OS; however, pN+ patients had better prognosis in DFS, RFS (at 2 and 5 years), and CSS (at 2, 5, and 10 years). Lymph node dissection provides a protective role in terms of 5-year OS and 5-year and 10-year CSS among UTUC patients. However, it is associated with higher risk of high-grade complications. The extent of dissection plays a minor prognostic role, while the positivity of resected nodes has great prognostic value in UTUC.

A prospective audit to assess the feasibility of sentinel lymph node biopsy and/or low axillary sampling in clinicoradiologically node-negative axilla for early breast carcinoma

Background: Sentinel lymph node (SLN) dissection was designed to minimize side effects of lymph node surgery but still offer outcomes of axillary lymph node dissection. Aims and Objectives: Our study is designed to determine whether SLN resection achieves the same therapeutics outcome as complete axillary dissection but with fewer side effects for node-negative axilla in clinicoradiologically operable breast cancer patients. Materials and Methods: Duration-based prospective observational study was carried out at the General Surgery and Surgical Oncology Department at Government Medical College and Hospital, Aurangabad with a duration of 2 ½ years from July 2019 to January 2022. A total of 36 patients of breast cancers with stages T1-T2, N0 with clinically and radiologically negative axilla from July 2019 to January 2022 duration were included in our study. Results: When the histopathological status of axillary lymph nodes was compared to the histopathology of SLNs it was seen that out of 36 patients, the histopathology of sentinel node was positive in 10 patients (10/36) however the rest of the axilla was positive in 6 cases and negative in 4 cases and the histopathology sentinel node was negative in 26 patients out of 36 cases (26/36) however the rest of the axilla was also negative in 24 cases and positive in 2 cases. Conclusion: SLN biopsy using methylene blue dye alone is a highly reliable and predictable technique to stage the axilla in breast cancer patients as this study shown a low false-negative rate (7.69%). This technique may help to avoid complete axillary lymph node dissection in sentinel node-negative patients thereby minimizing the morbidity of axillary lymph node dissection. This study demonstrates that sentinel node localization is possible with methylene blue dye alone.

Low axillary sampling to stage post neoadjuvant axilla in breast cancer patients - A practical approach in developing world

BackgroundPost-neoadjuvant sentinel lymph node biopsy or targeted axillary dissection in carcinoma breast patients need costly infrastructure, making it out of reach for resource constrained developing countries. This study assesses the diagnostic accuracy of low axillary node sampling to predict the nodal status of the post-chemotherapy node-negative axilla. Materials and methodsThis is a prospective study which included cytology proven node positive carcinoma breast patients who had node negative axilla after chemotherapy and underwent low axillary sampling with complete axillary lymph node dissection. Nodes below second intercostobrachial nerve were sent as low axillary sample. Results211 patients with carcinoma breast underwent FNAC of the axillary node prior to neoadjuvant systemic therapy (NAST). Low axillary sampling was performed on 77 patients who had clinically and radiologically node negative axilla after NAST. Out of 77, 24 (31%) had early breast cancer and 32 (41.5%) had T4 disease prior to NAST. In this cohort, 36 patients (47%) had a good biology tumour, 57 (74%) had Grade 3 tumour and 20 (26%) had lymphovascular invasion (LVI). Pathological complete response of breast and axilla was seen in 24 patients (31%). Low axillary sampling had a range of 1–12 nodes with median lymph nodal yield of 6. The false negative rate (FNR) of low axillary sampling was 8.3%. Good tumour biology, post NAST residual breast tumour and lymphovascular invasion were the independent predictors of positive low axillary nodes. ConclusionsLow axillary sampling is an economical and feasible option to de-escalate axillary surgery with acceptable false negative rate in carcinoma breast patients who had node negative axilla post neoadjuvant systemic therapy.

The Relationship Between the Resected Colon Length and the Number of Lymph Nodes in Colorectal Cancer: A Retrospective Cohort Study

Objective: The prognostic factors that are important for colorectal cancer are the pathological grade of the tumor and the existence of lymph node involvement. Currently, the curative treatment option is resection of the tumor with adequate length and margin along with complete dissection of lymph nodes draining the site of resection. Our study investigated into retrieving adequate lymph nodes for accurate staging as well as the relationship between lymph nodes and colon and rectum specimen length. Methods: This retrospective cross-sectional study examined the correlation between resected colon length and lymph node count in people with colorectal cancer diagnosed between January 2010 and June 2018. We defined a cutoff value for the segment length to be resected to allow adequate staging of the tumor. Furthermore, we examined the relationship between the resected segment lengths and survival. Results: Of the patients who were included in this study, 211 were men and 169 were women. The mean resected colon length was 26.47±17.09 cm and the mean dissected lymph node count was 29.05±20.84. There was a positive correlation between specimen length and total lymph node count as well as specimen length and the existence of reactive lymph nodes that were statistically significant (r=0.319, p=0.001; r=0.312, p=0.001, respectively). In our study, tumor localization was described in three regions: the right colon, left colon and rectum. The mean right colon region specimen length was 28.8±15.5 cm, while it was 22.0±11.0 cm for the left colon region, and 21.7±10.6 cm for the rectum region. The 5-year overall survival rate was 53.2%, whereas the 5-year disease-specific survival rate was 58.2%. Conclusion: The mean specimen length to achieve the cutoff value for adequate lymph node retrieval (least 12 lymph nodes) was 16 cm in our study (ROC curve, AUC=0.689±0.05, p=0.001). The resected colon length and the number of retrieved lymph nodes were positively correlated in our study. Based on this confirmation, a cutoff value of 16 cm was calculated to achieve an adequate segment length to be resected.

Impact of anesthesia choice in cutaneous melanoma surgery.

Invasive cutaneous melanoma is the most lethal skin cancer, but fortunately, the vast majority can be surgically treated with wide local excision, and sometimes additionally with sentinel or index lymph node biopsy for prognostication. Melanomas are particularly immunogenic malignancies, and preclinical studies have demonstrated that use of volatile anesthetics and opioids, unlike local agents, can suppress the immune system during the perioperative period. Immunosuppression has implications for creating a potentially favorable microenvironment for the survival and propagation of residual melanoma cells or micro-metastases, which could lead to disease relapse, both in the local tumor bed and distally. Results from observational clinical studies are mixed, but the literature would suggest that patients are at risk of decreased melanoma-specific survival after undergoing general anesthesia compared to regional anesthesia and spinal blocks. With the safety of close observation now established rather than automatic completion or total lymph node dissection for patients with either a positive sentinel lymph node biopsy or significant clinical response to neoadjuvant immunotherapy after index node sampling, the indications for definitive surgery with local or regional anesthesia have increased tremendously in recent years. Therefore, cutaneous melanoma patients might benefit from avoidance of general anesthesia and other perioperative drugs that suppress cell-mediated immunity if the option to circumvent systemic anesthesia agents is feasible.

Prognostic factors in cutaneous apocrine carcinoma: a single-institution retrospective study of 32 patients.

Cutaneous apocrine carcinoma (CAC) is a rare adnexal carcinoma. Limited data exists on the demographics and overall survival (OS) of patients with CAC; thus, there is no consensus on surgical management. This study aimed to examine demographic and survival data of patients with CAC to determine optimal surgical management. A single-center retrospective cohort study was conducted at the National Cancer Center Hospital in Tokyo between 2005 and 2022. Patients with a histologically-confirmed CAC diagnosis were identified and data on patient demographics, OS, and lymph node (LN) status were gathered. Thirty-two patients were included (median age, 65.5years; male-female ratio, 15:1). The most common involvement site was the axilla (87.5%). Of the nine patients in the clinical local stage, pathological LN metastases were found in five patients. Either pathological LN or distant metastases were present in 75% of the patients at initial diagnosis. The most common initial surgical treatments included wide local excision and complete LN dissection. Across cohorts, the median OS was 39months. Patients with ≥ 4 LN metastases had reduced recurrence-free survival and OS compared to those with ≤ 3 LN metastases (p = 0.042, p = 0.041, respectively). The OS was not remarkably different between patients who did and did not receive postoperative radiation therapy. Since CAC has a high rate of LN metastasis-and the number of LN metastases is a significant prognostic factor-LN evaluation should be considered for patients with CAC as initial treatment. Nonetheless, ≥ 4 LN metastases can be a poor prognostic factor for CAC.

Complete dissection of right paratracheal lymph nodes (stations 2R and 4R) is critical to improve the prognosis of lung cancer patients: A retrospective cohort study.

The optimal extent of mediastinal lymph node dissection is still under debate. This study aimed to investigate the prognostic impact of complete dissection of right paratracheal lymph nodes (LNs) in right-sided non-small cell lung cancer (NSCLC) and evaluate the potential patient population who will particularly benefit from right paratracheal node dissection (RPND). Between January 2009 and December 2019, we retrospectively reviewed 2650 patients with primary right-sided NSCLC who underwent pulmonary surgery with lymphadenectomy in the Western China Lung Cancer Database. A total of 2447 patients received both 2R and 4R LNs dissection (complete RPND group), 162 patients received only 2R or 4R LNs dissection (incomplete RPND group), and 41 patients received neither 2R nor 4R LNs dissection (no RPND group). Overall survival (OS) was analyzed. The metastasis rates in stations 2R and 4R were 6.5% and 8.0%, respectively. In stage N2 patients, the frequency of involvement of stations 2R/4R was 74.8%. The complete RPND group had a significantly better survival than the incomplete and no RPND group (5-year OS, 79.5% vs. 72.7% vs. 65.5%; p < 0.001). In the multivariate analysis, status of RPND (incomplete RPND vs. complete RPND: HR 1.45, 95% CI: 1.10-1.90; p = 0.009; no RPND vs. complete RPND: HR 2.25, 95% CI: 1.37 to 3.69; p = 0.001), age, gender, tumor size, histological type, pTNM stage, pT stage, pN stage, and adjuvant treatment were independent factors for OS. Complete RPND brings survival benefits to patients with right-sided NSCLC. We suggest complete RPND as a standard procedure for patients with right-sided NSCLC.