Greater Number Of Lymph Nodes Research Articles

Enzymatic Fat Dissolution Improves Detection of Small Lymph Nodes in Colon Cancer Surgery.

Background Accurate lymph node evaluation is essential for staging colon cancer and guiding postoperative treatment decisions. In this study, we compared the efficacy of a simple enzymatic fat dissolution method with the conventional method for lymph node sampling from specimens after colon cancer surgery. Methods We enrolled 58 patients who underwent elective laparoscopic surgery for colon adenocarcinoma between May 2018 and May 2021 at Fukuoka University Hospital in Fukuoka, Japan. The specimens from these patients were treated using fat dissolution and were compared with specimens from 58 patients for which conventional manual palpation was used. Results A significantly greater number of lymph nodes were detected by the fat dissolution method compared with the conventional method (average per patient, 27.5 vs. 22.6, P = 0.02). In particular, the between-group difference was significant for lymph nodes measuring <5 mm (average per patient, 26.1 vs. 20.9; P = 0.01). Multivariate analysis showed that, compared with the conventional method, the fat dissolution method was significantly associated with the identification of lymph node metastasis. The positive rate of lymph nodes ≥10 mm in diameter was markedly higher along the inferior mesenteric artery than the ileocolic artery (100% vs. 52.6%). Conclusions The use of the fat dissolution method led to an increase in the number of small lymph nodes detected. Rates of metastasis according to lymph node size may depend on the lymph node station.

Comparison of Short-Term Outcomes After Robotic Versus Laparoscopic Radical Gastrectomy for Advanced Gastric Cancer in Elderly Individuals: A Propensity Score-Matching Study.

Robotic gastrectomy (RG) has been widely used to treat gastric cancer. However, whether the short-term outcomes of robotic gastrectomy are superior to those of laparoscopic gastrectomy (LG) for elderly patients with advanced gastric cancer has not been reported. The study enrolled of 594 elderly patients with advanced gastric cancer who underwent robotic or laparoscopic radical gastrectomy. The RG cohort was matched 1:3 with the LG cohort using propensity score-matching (PSM). After PSM, 121 patients were included in the robot group and 363 patients in the laparoscopic group. Excluding the docking and undocking times, the operation time of the two groups was similar (P = 0.617). The RG group had less intraoperative blood loss than the LG group (P < 0.001). The time to ambulation and first liquid food intake was significantly shorter in the RG group than in the LG group (P < 0.05). The incidence of postoperative complications did not differ significantly between the two groups (P = 0.14). Significantly more lymph nodes were dissected in the RG group than in the LG group (P = 0.001). Postoperative adjuvant chemotherapy was started earlier in the RG group than in the LG group (P = 0.02). For elderly patients with advanced gastric cancer, RG is safe and feasible. Compared with LG, RG is associated with less intraoperative blood loss; a faster postoperative recovery time, allowing a greater number of lymph nodes to be dissected; and earlier adjuvant chemotherapy.

The short- and long-term outcomes of laparoscopic D2 lymphadenectomy plus complete mesogastrium excision for lymph node-negative gastric cancer.

Patients with T1-3N0M0 gastric cancer (GC) who undergo radical gastrectomy maintain a high recurrence rate. The free cancer cells in the mesogastric adipose connective tissue (Metastasis V) maybe the reason for recurrence in these individuals. We aimed to evaluate whether D2 lymphadenectomy plus complete mesogastrium excision (D2 + CME) was superior to D2 lymphadenectomy with regard to safety and oncological efficacy for T1-3N0M0 GC. Patients with T1-3N0M0 GC who underwent radical resection from January 2014 to July 2018 were retrospectively analyzed; there were 323 patients, of whom 185 were in the D2 + CME group and 138 in the D2 group. The primary endpoint was 5-year disease-free survival (DFS). Secondary endpoints include the 5-year overall survival (OS), recurrence pattern, morbidity, mortality, and surgical outcomes. D2 + CME was associated with less intraoperative bleeding loss, a greater number of lymph nodes harvested, and less time to first postoperative flatus, but the postoperative morbidity was similar. The 5-year DFS was 95.6% (95% CI 92.7-98.5%) and 90.4% (95% CI 85.5-95.3%) in the D2 + CME group and the D2 group, respectively, with a hazard ratio (HR) of 0.455 (95% CI 0.188-1.097; p = 0.071). In terms of recurrence patterns, local recurrence was more prone to occur in the D2 group (p = 0.031). Subgroup analysis indicated that for patients with T1b-3N0M0 GC, the 5-year DFS in the D2 + CME group was considerably greater than that in the D2 group (95.3% [95% CI 91.6-99.0%] vs. 87.6% [95% CI 80.7-94.5%], HR 0.369, 95% CI 0.138-0.983; log-rank p = 0.043). Laparoscopic D2 + CME for T1-3N0M0 GC is safe and feasible. Furthermore, it not only reduces the local recurrence rate but also improves the 5-year DFS in cases of T1b-3N0M0 GC.

Concurrent radiotherapy cannot provide superiority of surgical oncological outcome and long-term survival rate in locally advanced esophageal squamous cell carcinoma patients receiving neoadjuvant chemotherapy followed by minimally invasive esophagectomy.

To evaluate effectiveness of concurrent radiotherapy in esophageal cancer patient treated with neoadjuvant therapy. The data of 1026 consecutive esophageal squamous cell carcinoma (ESCC) patients who underwent minimally invasive esophagectomy (MIE) were retrospectively collected. The main inclusion criteria were patients with locally advanced (cT2-4N0-3M0) ESCC who underwent neoadjuvant chemoradiotherapy (NCRT) or neoadjuvant chemotherapy (NCT) followed by MIE, and divided into two groups according to different neoadjuvant strategies. Propensity score matching was performed to improve the comparability between the two groups. After exclusion and matching, 141 patients were enrolled retrospectively: 92 received NCT, and 49 received NCRT. No difference in clinicopathologic characteristics or incidence of adverse events between groups. A shorter operation time (215.7 ± 35.5min) (p < 0.001), less blood loss (111.2 ± 67.7ml) (p = 0.0007) and a greater number of lymph nodes retrieved (33.8 ± 11.7) (p = 0.002) were observed in NCT group than in NCRT group. The incidence of postoperative complications was similar between groups. Although patients in NCRT group had better pathological complete response (16, 32.7%) (p = 0.0026) and ypT0N0 (10, 20.4%) (p = 0.0002) rates, there was no significant difference in 5-year progression-free survival (p = 0.1378) or disease-specific survival (p = 0.1258) between groups. Compared with NCRT, NCT has certain advantages in that it can simplify the surgical procedure and decrease the surgical technique required without compromising the surgical oncological outcomes and long-term survival of patients.

Multidimensional evaluation of the learning curve for totally laparoscopic pancreaticoduodenectomy: a risk-adjusted cumulative summation analysis

IntroductionLaparoscopic pancreaticoduodenectomy (LPD) is a challenging procedure. We investigated the learning curve (LC) for LPD with a multidimensional analysis. MethodsData of patients undergoing LPD between 2017 and 2021, operated by a single surgeon, were considered. A multidimensional assessment of the LC was performed through Cumulative Sum (CUSUM) and Risk-Adjusted (RA)-CUSUM analysis. Results113 patients were selected. Rates of conversion, overall postoperative complication, severe complication and mortality were 4%, 53%, 29% and 4%, respectively. RA-CUSUM analysis showed a LC with three phases: competency (procedures 1–51), proficiency (procedures 52–94), and mastery (after procedure 94). Operative time was lower in both phase two (588.17 vs 541.13 min, p = 0.001) and three (534.72 vs 541.13 min, p = 0.004) with respect to phase one. Severe complication rate was lower in mastery as compared to competency phase (42% vs 6%, p = 0.005). During mastery phase a greater number of lymph nodes was harvested in comparison to proficiency phase. ConclusionsAccording to our LC analysis, 52 procedures were required to achieve technical competency in LPD. Mastery, which corresponded to a reduction in operative time and surgical failures, was acquired after 94 procedures.

Adjuvant Chemoradiotherapy Associated with Improved Overall Survival in Resected Esophageal Squamous Cell Carcinoma after Neoadjuvant Chemoradiotherapy in Intensity-Modulated Radiotherapy Era.

The prognosis of patients with resected esophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy is particularly poor in those who were staged as ypT3/T4 and/or ypN+. This study investigated whether adjuvant chemoradiotherapy was associated with improved clinical outcomes in these patients. we identified patients with esophageal squamous cell carcinoma who were staged as ypT3/T4 and/or ypN+ after being treated with neoadjuvant chemoradiotherapy followed by esophagectomy between the years 2013 and 2019. Patients were divided into two groups based on whether they received adjuvant chemoradiotherapy. The Kaplan-Meier method and Cox regression modeling were performed for survival analyses and multivariable analysis, respectively. 76 eligible patients were included in the analyses. The median follow-up for the study cohort was 43.4 months. On Kaplan-Meier analyses of the overall population, adjuvant chemoradiotherapy was associated with significantly improved median overall survival (31.7 months vs. 16.3 months, p = 0.036). On Kaplan-Meier analyses of the 35 matched pairs generated by propensity score matching, adjuvant chemoradiotherapy was associated with significantly longer median overall survival (31.7 months vs. 14.3 months; p = 0.004) and median recurrence-free survival (18.9 months vs. 11.7 months; p = 0.020). In multivariable analysis, adjuvant chemoradiotherapy was independently associated with a 60% reduction in mortality (p = 0.003) and a 48% reduction in risk of recurrence (p = 0.035) after adjusting for putative confounders. In addition, microscopic positive resection margin and Mandard tumor regression grade 3-4 were independently associated with increased mortality and risk of recurrence. While a greater number of lymph nodes dissected was independently associated with significantly improved overall survival, the number of positive lymph nodes was independently associated with significantly worse overall survival and a trend (p = 0.058) towards worse recurrence-free survival. This study demonstrated that adjuvant CRT was independently associated with a significantly improved survival and lower risk of recurrence than observation in esophageal squamous cell carcinoma patients staged as ypT3 and/or ypN+ after receiving neoadjuvant chemoradiotherapy and radical surgery. The results of this study have implications for the design of future clinical trials and may improve treatment outcomes of patients in this setting who cannot afford or are without access to adjuvant nivolumab.

Patterns of postmastectomy radiation therapy in clinically node-positive breast cancerpatients with pathologically negative lymph nodes after neoadjuvant chemotherapy.

To analyze postmastectomy radiation therapy (PMRT) utilization and its association with overall survival (OS) in patients presenting with node-positive breast cancer who are pathologically node-negative (ypN0) after neoadjuvant chemotherapy (NAC). Using the National Cancer Data Base (NCDB), we identified patients diagnosed between 2004 and 2013 with clinical T1-4 node-positive nonmetastatic breast cancer who received NAC and underwent mastectomy with pathologically negative lymph node sampling. Multivariable regression models identified factors associated with PMRT use. The Cox proportional hazards model was used to evaluate predictors of mortality. The study included 8766 clinically node-positive patients who met the study criteria. PMRT was delivered to 61.5% of patients. Overall PMRT utilization rate increased over the study period from 54.4% in 2004 to 65.2% in 2011. Predictors of PMRT use included larger tumor size, increasing clinical N stage, higher grade disease, receipt of hormone therapy, and a greater number of lymph nodes examined. The unadjusted 5-year OS was 84.1% in the PMRT group and 83.8% in the non-PMRT group (p = NS). PMRT was not significantly associated with survival on multivariable analysis (hazard ratio [HR] 0.87; 95% confidence interval [CI] 0.73-1.03). The delivery of PMRT has increased over time in women presenting with clinically node-positive breast cancer who convert to ypN0 after NAC. While we identified multiple independent socioeconomic and clinical predictors of both PMRT utilization and survival, PMRT itself was not significantly associated with survival.

Application of laparoscopic and open gastrectomy in enhanced recovery after surgery for gastric cancer: analysis of data from multiple centers in China

To evaluate the clinical efficacy of laparoscopic and open gastrectomy in enhanced recovery after surgery (ERAS) for gastric cancer. We retrospectively collected the clinicopathological data of gastric cancer patients undergoing radical gastrectomy at 12 Chinese medical centers between January, 2015 and December, 2017. We analyzed the clinical outcomes of a total of 1569 patients, including 552 patients undergoing open surgery, 1004 receiving laparoscopic surgery, and 43 experiencing conversion of laparoscopic surgery to open surgery. The operative outcomes and postoperative complications of the patients in laparoscopic group and open surgery group were analyzed. The primary outcome was the short-term postoperative complications. The secondary outcomes included operation time, estimated blood loss, number of lymph node dissection, time to first liquid diet intake, time to first passage of flatus and defecation, time to ambulation, postoperative hospitalization days and occurrence of readmission within 30 days. Of the total of 1569 patients, 1037 (66.1%) were males and 532 (33.9%) were females, with a mean age at diagnosis of 58.4±11.3 years. A total of 105 patients (6.7%) underwent proximal gastrectomy, 877 (55.9%) underwent distal gastrectomy, and 587 (37.4%) underwent total gastrectomy. In the overall patients, the operation time was 274.7±80.7 mins, blood loss was 150 (20-1300) mL, and the number of lymph nodes dissected was 29.9±13.5. The time to first ambulation, flatus, defecation and liquid food intake were 2.3±1.2, 3.4±1.6, 4.8±1.8 and 5.5±3.1 days, respectively. The postoperative hospital stay was 11.4±5.0 days. The incidence of postoperative complications (Clavien-Dindo score ≥Ⅱ) was 6.5%, and the rate of readmission within 30 days after discharge was 1.1%. Subgroup analysis of the patients based on the surgical approach (conversion of laparoscopic surgery to open surgery was considered open surgery) showed no significant differences in the extent of gastrectomy between laparoscopic and open surgery groups (P > 0.05). Compared with those in the open surgery group, the patients having laparoscopic gastrectomy had a greater number of lymph nodes retrieved with earlier ambulation, first flatus, defecation and oral intake and a shorter postoperative hospital stay (P < 0.05). The laparoscopic group had a lower intraoperative blood loss but a longer operation time than the open surgery group (P < 0.05). The incidence of postoperative complications did not differ significantly between the two groups (P > 0.05). Compared with open surgery, laparoscopic surgery in ERAS can shorten the time to ambulation, first flatus, defecation, and oral intake and the length of hospital stay. Laparoscopic surgery can achieve the same oncological outcomes as open surgery without increasing postoperative complications.

Factors Influencing Lymph Node Retrieval in Colorectal Adenocarcinoma.

Retrieval and examination of an adequate number of lymph nodes is an essential part of the correct staging of colorectal adenocarcinoma. The surgeon, pathologist, and factors inherent to patient and tumor affect lymph node yield. This study aims to evaluate the influence of patient and tumor characteristics upon lymph node retrieval by analyzing the mean number of lymph nodes and to assess whether these variables are specifically associated with adequate lymph node sampling. A retrospective study on colectomy specimens of colorectal adenocarcinoma was performed in the Department of Pathology, Patan Academy of Health Sciences, Nepal from April 2011 to October 2019. Variables including age, gender, anatomical location, tumor size, grade, lymphovascular invasion, perineural invasion, length of the surgical specimen, T stage, N stage, and AJCC stage were analyzed to determine their impact on the number of lymph nodes retrieved. The variables were also analyzed to determine their influence on adequate lymph node retrieval. Gender, age, maximum tumor size, grade, lymphovascular invasion, perineural invasion, T stage, N stage, and AJCC stage showed no statistically significant association. Right-sided adenocarcinoma yielded a notably greater number of lymph nodes with a higher probability of adequate lymph node sampling. Significantly more lymph nodes were retrieved in longer surgical specimens. Right-sided location and longer surgical specimens were associated with higher lymph node retrieval in colorectal adenocarcinoma.

Propensity-matched Comparison of VATS Left Upper Trisegmentectomy and Lobectomy

BackgroundThis study aimed to investigate the oncologic outcomes of video-assisted thoracoscopic (VATS) left upper trisegmentectomy (LTS) vs left upper lobectomy (LUL) for patients presenting with stage I non-small cell lung cancer (NSCLC). MethodsA retrospective analysis identified 1543 consecutive patients presenting to Shanghai Pulmonary Hospital (Shanghai, China) with NSCLC for VATS LTS or LUL from 2013 to 2017. After propensity-score matching for patient demographics and tumor characteristics, 273 pairs were identified. Disease-free survival (DFS) and overall survival (OS) were estimated by the Kaplan-Meier method and compared using the log-rank test. ResultsThe median follow-up time was 51.5 months. There were no significant differences in operative duration (2.11 ± 0.64 hours vs 2.49 ± 5.96 hours; P = .30), total blood loss (106.19 ± 170.83 mL vs 97.07 ± 149.34 mL; P = .51), and operative complications (10% vs 8%; P = .37) between the LUL and LTS groups. Patients undergoing LUL had longer postoperative hospital stays (5.55 ± 3.00 days vs 4.87 ± 2.33 days; P = .003), greater tumor margin distance (3.3 ± 1.2 cm vs 3.1 ± 0.9 cm; P < .001), and greater number of lymph nodes harvested (8.0 ± 3.2 vs 6.8 ± 3.3; P < .001) than patients undergoing LTS, but the margin-to-tumor ratio was not statistically different (2.5 ± 1.6 vs 2.3 ± 1.1; P = 0.11). Median DFS (49.5 months vs 54.3 months; P = .77) and OS (49.5 months vs 55.0 months; P = .88) were not significantly different between patients undergoing LTS and those undergoing LUL, and similar outcomes were noted across subgroups of patients stratified by tumor stage, pathologic type, and radiographic manifestations. ConclusionsVATS LTS and LUL had comparable oncologic outcomes for stage I NSCLC, regardless of tumor pathologic types and radiologic findings, as long as negative margins were confirmed.

Patterns of post-mastectomy radiation therapy in clinically node positive breast cancer patients with pathologically negative lymph nodes after neoadjuvant chemotherapy.

To analyze postmastectomy radiation therapy (PMRT) utilization and its association with overall survival (OS) in patients presenting with node positive breast cancer who are pathologically node negative (ypN0) after neoadjuvant chemotherapy (NAC). Using the National Cancer Data Base (NCDB), we identified patients diagnosed between 2004 and 2013 with clinical T1-4 node-positive non-metastatic breast cancer who received NAC and underwent mastectomy with pathologically negative lymph node sampling. Multivariable regression models identified factors associated with PMRT use. The Cox proportional hazards model was used to evaluate predictors of mortality. The study included 8,766 clinically node-positive patients who met the study criteria. PMRT was delivered to 61.5% of patients. Overall PMRT utilization rate increased over the study period from 54.4% in 2004 to 65.2% in 2011. Predictors of PMRT use included larger tumor size, increasing clinical N stage, higher grade disease, receipt of hormone therapy, and greater number of lymph nodes examined. Unadjusted 5-year OS was 84.1% in the PMRT group and 83.8% in the non-PMRT group (p=NS). PMRT was not significantly associated with survival on multivariable analysis (hazard ratio [HR] 0.87; 95% confidence interval [CI] 0.73-1.03). The delivery of PMRT has increased over time in women presenting with clinically node positive breast cancer who convert to ypN0 after NAC. While we identified multiple independent socioeconomic and clinical predictors of both PMRT utilization and survival, PMRT itself was not significantly associated with survival.

Platelet/Lymphocyte Ratio Is Superior to Neutrophil/Lymphocyte Ratio as a Predictor of Chemotherapy Response and Disease-free Survival in Luminal B-like (HER2−) Breast Cancer

BackgroundThe neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) have been associated with the prognosis in breast cancer (BC). The relationship of the NLR and PLR with chemotherapy sensitivity and prognosis in luminal B-like (human epidermal growth factor receptor 2-negative [HER2−]) BC are not well studied. Patients and MethodsThe clinical data from 980 patients with luminal B-like (HER2−) BC from June 2012 to June 2016 were collected. The differences among the variables were calculated using the χ2 test. The associations among the clinicopathologic factors, pretreatment NLR, pretreatment PLR, and disease-free survival (DFS) were analyzed using Kaplan-Meier curves and Cox analyses. ResultsThe median follow-up was 37 months (range, 5-77 months). For the 480 patients who had received neoadjuvant chemotherapy, low pretreatment PLR values were associated with higher pathologic complete response (pCR) rates compared with the high PLR group (15.8% for low vs. 9.2% for high PLR group; P = .027). Multivariate analyses showed that larger tumors, a greater number of lymph nodes involved, a high Ki-67 score, and a high PLR were independent prognostic factors of worse outcomes for the patients with luminal B-like (HER2−) BC. The risk of metastasis and/or recurrence was greater for the high PLR group than for the low PLR group (hazard ratio, 1.576; 95% confidence interval, 1.039-2.390; P = .032). The pretreatment NLR showed no such associations among this cohort of patients. ConclusionsThe results of the present study have shown that the pretreatment PLR is superior to the NLR as a predictor of pCR and DFS outcomes in patients with luminal B-like (HER2−) BC. A low pretreatment PLR was associated with higher pCR rates after neoadjuvant chemotherapy and was an independent predictive factor for better DFS outcomes among patients with luminal B-like (HER2−) BC.

Eliminating microscopic lymph node metastasis by performing pelvic lymph node dissection during radical prostatectomy for prostate cancer.

The oncological benefit of pelvic lymph node dissection (PLND) for prostate cancer (PCa) remains unclear. The therapeutic effect of PLND on the elimination of microscopic metastases during radical prostatectomy (RP) for PCa was examined in the current study. A total of 348 Japanese patients with high- or intermediate-risk PCa without lymph node metastasis, who underwent antegrade RP at the Kyushu Cancer Center (Fukuoka, Japan) between August 1998 and May 2013 were retrospectively analyzed. The patients were divided into the standard (obturator + internal iliac nodes) group and the expanded (standard + additional nodes) group according to the extent of PLND. Preoperative and postoperative characteristics were also analyzed to determine the factors associated with prostate-specific antigen (PSA) failure. Standard and expanded PLND were performed in 70.9% (247/348) and 29.1% (101/348) of cases, respectively. The results revealed that preoperative PSA levels were the only marked difference between the two groups. No differences were observed in the other preoperative and postoperative characteristics. Furthermore, the rate of PSA recurrence in each group did not differ to a statistically significant extent (P=0.3622). Reducing the area of dissection from expanded PLND to standard PLND significantly reduced the number of dissected lymph nodes (P<0.0001). Additionally, the PSA level, clinical tumor stage, Gleason score of the biopsy specimen, pathological tumor stage and extent of PLND were all associated with PSA recurrence, as determined via multivariate Cox hazards regression analysis (P=0.0177, P=0.0023, P=0.0027, P<0.0001 and P=0.0164, respectively). In high- and intermediate-risk patients without lymph node metastasis, a greater number of lymph nodes were dissected when the extent of dissection was greater. Furthermore, the extent of PLND was a significantly associated with PSA failure. The results indicated that PLND exerted a therapeutic effect by eliminating microscopic pelvic lymph node metastases that were not detected by routine pathological examinations.

Breast Cancer Recurrence and Study of Factors Associated with Survival after Recurrence

Background: Breast cancer is the most occurring threat for women across world, survival of this deadly disease is effected by recurrence after primary treatment. This study was aimed to understand survival times, hazard ratios and prognostic factors of breast cancer after recurrence. Methods: This study was conducted on 1028 Pakistani women through retrospective design from February, 2011 to February, 2018 at Punjab, Pakistan. Factors were analyzed using statistical tools and techniques to find out rate of mortality after recurrence. Descriptive statistics, univariate and multivariate hazard ratios were calculated, which are helpful for clinicians to make therapeutic strategies for breast cancer patients. Results: From the total of 1028 patients 447 observed mortality due to breast cancer with in follow-up time after recurrence, while 581 were still alive or had expired due to other reasons. Median survival time after recurrence was 3 years. Survival of breast cancer patients depends upon many factors. Multivariate model was used to find out predictors of death. Significant factors included post- menopausal women who were diagnosed breast cancer of grade 11 and 111 at the age ≤ 45 and/or ≥ 56, recurrence age ≤ 45, estrogen receptor positive, progesterone receptor negative and Her2.neu positive with tumor size ≥ 4 &amp; involved lymph nodes ≥ 6. Conclusions: At younger age survival of patients had decreased after recurrence. Chemotherapy as a primary treatment had statistically significant effect on lower mortality for women recurred. Progesterone receptor negative have greater chances of mortality .Grade 11 &amp; 111 tumor with, larger tumor size and greater number of lymph nodes had the highest hazards.

Study of lymph node vascular relationships of the inferior epigastric veins: The solve anatomical study

Tissue surrounding the superficial inferior epigastric vein (SIEV) can be harvested for vascularised lymph node transfer (vLNT) for the treatment of lymphoedema. The aim of this study is to define the anatomical relationship of lymph nodes surrounding the SIEV. Twenty-five fresh-frozen cadaveric groin specimens were harvested en bloc to the level of the deep fascia along the following anatomical boundaries, yielding quadrilateral tissue blocks: pubic tubercle (medial), anterior superior iliac spine (lateral), 5 cm superior and inferior to the inguinal ligament. The SIEV was marked at its entry point with the femoral vein. Specimens were oriented, secured and fixed in formaldehyde and analysed using longitudinal slices at 3 mm intervals. A total of 86 lymph nodes were identified. The average position of lymph nodes examined was 0.4 cm medial and 3.2 cm inferior to the mid-inguinal point. An improved understanding of the anatomical locations of lymph nodes surrounding the SIEV will allow a more purposeful harvest during vLNT, allowing a greater number of lymph nodes to be captured whilst limiting donor site morbidity.

Comparison of postoperative complications between different operation methods for esophageal cancer.

BackgroundWe explored the selection of surgical method and differences in postoperative complications in patients with esophageal cancer (EC).MethodsThe data of 434 patients with EC who underwent thoracic surgery at the Jiangsu Provincial People's Hospital between January 2011 and December 2016 were collected. Patients were divided into three groups: Sweet surgery (143 cases), Ivor–Lewis surgery (232 cases), and minimally invasive esophagectomy (MIE, 59 cases). The number of postoperative days, number of lymph nodes dissected, and incidence of pulmonary infection, serous membrane fluid, arrhythmia, chylous fistula, gastric emptying dysfunction, and anastomotic leakage were recorded.ResultsA statistically significant number of female stage I patients with upper EC underwent MIE (P < 0.05). Postoperative complications were observed in all three groups but were not statistically significant (P > 0.05). A greater number of lymph nodes were dissected in the Ivor–Lewis group compared to the other groups (P < 0.05).ConclusionClinically, MIE is often selectively used for women with upper and mid‐early EC, especially in stage I. In our sample, more lymph nodes were dissected in the Ivor–Lewis than in the MIE group, which can reduce recurrence and improve the survival rate. Ivor–Lewis surgery is often used in mid‐lower and terminal EC, while MIE is often used in upper and mid‐early EC. Compared to the other surgical methods, MIE does not increase the risk of postoperative complications. The gradual maturation of MIE technology will further expand indications and increase the number of lymph nodes dissected.

Postoperative radiotherapy for stage II or III non–small cell lung from 1988 to 2014.

e20013 Background: In 2006 ASCO, Brian E. Lally et al. reported the association between survival and postoperative radiotherapy (PORT) in patients with resected non–small-cell lung cancer (NSCLC). We now undertook a update analysis using the latest data. Methods: Updated data were obtained by the Surveillance, Epidemiology and End Results database. We analyzed stage II or III NSCLC patients diagnosed between 1988 and 2014. Results: A total of 20645 patients were selected, with a median follow-up time of 3.3 years. Predictors for the use of PORT included age less than 50 years, higher AJCC stage, T3-4 tumor stage, larger tumor size, advanced node stage, greater number of lymph nodes involved, and a higher ratio of lymph nodes involved to lymph nodes sampled. On multivariate analysis, male sex, older age, T3-4 tumor stage, N2 node stage, fewer sampled lymph nodes, higher positive lymph nodes and higher ratio of lymph nodes involved to lymph nodes sampled had a negative impact on survival. PORT had a significant adverse effect on survival, regardless of all patients (P &lt; 0.001), or N0 subgroup ( P&lt; 0.001) or N1 subgroup (P&lt; 0.001). For N2 subgroup, PORT did not have a significant effect of on survival (P &lt; 0.117). This is different from the result Brian E. Lally et al. reported in ASCO 2006. Conclusions: Postoperative radiotherapy is detrimental to resected N0 or N1 NSCLC patients and should not be used routinely for such patients. The role of postoperative radiotherapy in the treatment of N2 tumours is not clear and may warrant further research.

Cephalic duodenopancreatectomy resection: technique, morbidity and mortality

Background: Advances in recent decades in the massive form of diagnostic techniques for images, a better understanding of pancreatic diseases and management pre, intra, and postoperative patients has affected in some centres of reference, a significant reduction of mortality and an increase in the survival of the cephalic pancreaticoduodenectomy for the treatment of malignant and benign tumours of the confluent bile-duodenum-pancreatic today this surgery is performed with acceptable morbidity and mortality. The objective of this study is to evaluate the incidence of the disease, pancreatic resection technique, morbidity and mortality of the Pancreaticoduodenectomy. Methods: Between December 2000 and December 2014, 96 PDC have been operated. Of them, 54 male and 42 female, whose ages ranged from 27 to 79 years old (average of 59 years) In relation of symptoms, in 89 patients had weight loss which varied between 4 to 15 kg, 83 opportunities presented jaundice, in 82 cases looked for pain, 51 vomiting and fever in 14 cases. All the patients out an ultrasound of the abdomen, to detect 80 times allowed observing tumours, noting in addition in 82 cases the main bile duct dilatation. Likewise, was performed in all patients a CT scan of the abdomen, which showed in 86 opportunities dilatation of Wirsung duct and 89 cases bile duct dilatation hepatic intra and extra hepatic. Results: All patients underwent a PD and as it is our custom, trying to expand the pancreatic resection as much as possible to the left of the mesenteric-portal axis in patients with tumours of the head of pancreas and lymphadenectomy in the hepatic pedicle prolonged by the artery to the celiac trunk. In addition, we have extended lymphadenectomy to the superior mesenteric artery and tissue retro-portal. We rebuild by pancreatic-jejunostomy term-terminal invagination anastomosis with a tutor in the Wirsung duct in cases of pancreas mild. 10-15 cm from it makes the hepatico-jejunostomy anastomosis end-side. About 40 cm of pancreatic-jejunostomy anastomosis jejunum is sectioned to make a Y -shaped Roux, whose distal sector, previous close terminal, allow the gastro-jejunostomy With respect to mortality within 30 days, 5 patients (4, 80%) died. Subsequently, 5 more patients died within 90 days (9.3%). With respect to morbidity, we divide them into in two, clinics that were 17 patients (16.32%), which were 3 lung disease, 6 febrile syndromes, 4 diabetes, 1 arrhythmia, 1 IAM, respiratory failure and an atrial fibrillation last two died. 50 patients were surgical (48%). Within pancreatic fistula was in 32 patients (30, 72%), divided into type A: in 25 cases (24%) where there was no clinical impact, type B: 4 opportunities (3.84%) and finally type C: 3 (2.88%), which one of them after being intervened. C patient died. With respect to the gastric emptying was present in 19 (18.24%) who had more than 10 days the SNG. Finally 5 (4.80%) had intra peritoneal bleeding, which were re intervened and one of them died. In addition, 8 patients had a biliary fistula (7.62%). Conclusion: Finally, we would like to talk about strong evidence that high-volume centres have lower mortality than low-volume centres. There is evidence that patients treated at high-volume centres have reduced surgical mortality and morbidity, higher survival in the long term, greater number of lymph nodes in the surgical specimen, increased frequency of R0, less hospital stay, and generate lower costs. The Results of our work support the concept that surgeons with low volume of PDC annually, but with strict training in institutions with adequate infrastructure and a multidisciplinary team, can also get good results in the malignant and benign lesions of biliary-duodenum-pancreatic confluent.

Fluorescent Lymphography–Guided Lymphadenectomy During Robotic Radical Gastrectomy for Gastric Cancer

ImportanceFluorescent imaging with indocyanine green can be used to visualize lymphatics. Peritumoral injection of indocyanine green may allow for visualization of every draining lymph node from a primary lesion on near-infrared imaging.ObjectivesTo evaluate the role of fluorescent lymphography using near-infrared imaging as an intraoperative tool for achieving complete lymph node dissection and compare the number of lymph nodes retrieved with the use of near-infrared imaging and the number of lymph nodes retrieved without the use of near-infrared imaging.Design, Setting, and ParticipantsThis prospective single-arm study was conducted among 40 patients who underwent robotic gastrectomy between August 30, 2013, and July 21, 2014, at a single-center, tertiary referral teaching hospital. After propensity score matching, the results of these 40 patients were compared with the results of 40 historical control patients who underwent robotic gastrectomy without indocyanine green injection between January 1, 2012, and August 31, 2013. Statistical analysis was performed from January 1, 2015, to July 31, 2016.InterventionsRobotic gastrectomy with systemic lymphadenectomy and retrieval of lymph nodes under near-infrared imaging after peritumoral injection of indocyanine green to the submucosal layer 1 day before surgery.Main Outcomes and MeasuresThe primary outcome was the number of retrieved lymph nodes in each nodal station.ResultsAmong the 40 patients in the study (19 women and 21 men; mean [SD] age, 52.2 [11.7] years), no complications related to indocyanine green injection or near-infrared imaging were observed. On completion of the lymphadenectomy, the absence of fluorescent lymph nodes in the dissected area was confirmed. A mean (SD) total of 23.9 (9.0) fluorescent lymph nodes were recorded among a mean (SD) total of 48.9 (14.6) overall lymph nodes retrieved. The mean number of overall lymph nodes retrieved was larger in the near-infrared group than in the historical controls (48.9 vs 35.2; P < .001), with a significantly greater number of lymph nodes retrieved at stations 2, 6, 7, 8, and 9. In the near-infrared group, 5 patients exhibited lymph node metastases, and all metastatic lymph nodes were fluorescent.Conclusions and RelevanceThis study’s findings suggest that fluorescent lymphography may be useful intraoperatively for identifying and retrieving all necessary lymph nodes for a complete and thorough lymphadenectomy.

The impact of the number of harvested central lymph nodes on the lymph node ratio

ObjectiveThe purpose of this study was to analyze the impact of lymph node harvest on the lymph node ratio (LNR). MethodsWe retrospectively reviewed 106 patients diagnosed preoperatively with PTMC (papillary thyroid microcarcinoma), no evidence of central or lateral neck nodal metastasis, and who underwent a total thyroidectomy and bilateral central lymph node neck dissection (CND). ResultsThe median number of retrieved lymph nodes in the central compartments was 7±6.59 (range: 1–42). The mean number of metastatic lymph nodes in the central compartments on pathology was 1.1±1.79 (range: 0–7). The high node volume group (>7) had a significantly higher rate of central lymph node (CLN) metastasis than the low node volume group (≤7) in the final pathologic report (p<0.001). With the linear regression method, the number of CLN metastasis increased as the number of retrieved lymph nodes increased (correlation coefficient=0.286, p=0.003). The multivariate analysis confirmed the number of retrieved lymph nodes in the central compartments was a risk factor for high LNR (p=0.008, odds ratio 3.737). The rates of vocal fold palsy and hypoparathyroidism did not differ according to the number of retrieved lymph nodes. ConclusionThe lymph node ratio in the final pathologic report is larger when a greater number of lymph nodes are retrieved during the central compartment neck dissection.