Higher Number Of Lymph Nodes Research Articles

Clinicopathologic factors associated with pathologic upstaging in patients clinically diagnosed stage T2N0M0 squamous cell esophageal carcinoma.

Even with the use of contrast-enhanced thin-layer chest computed tomography (CT) and endoscopic ultrasonography (EUS), the likelihood of cT2N0M0 squamous cell esophageal cancer correlating with the final pathologic outcome is exceedingly low. We therefore sought to investigate the associations between different risk factors and pathologic upstaging in stage T2N0M0 esophageal cancer patients who underwent esophagectomy. We retrospectively reviewed the clinicopathological characteristics of 224 stage T2N0M0 squamous cell esophageal cancer patients who underwent complete resection over a 2-year period (October 2016-September 2018). The tumor volume (TV) was automatically measured from thin-layer chest CT scans using imaging software. Univariate and multivariate analyses were performed to identify the risk factors associated with upstaging. A receiver operating characteristic (ROC) curve was plotted, and its ability to identify pathological upstaging was assessed. A total of 224 patients with clinical stage T2N0M0 squamous cell esophageal carcinoma (SCEC) underwent esophagectomy; of these patients, 96 (42.86%) had a more advanced stage during the final pathologic review than during the initial diagnosis. The risk factors for pathologic upstaging included a large TV, high total cholesterol (TC), high triglycerides (TGs), high platelet-to-lymphocyte ratio (PLR), and high number of lymph nodes examined. The ROC analysis demonstrated an area under the curve of 0.845 (95% confidence interval 0.794-0.895). In SECC diagnosed as stage T2N0M0 by CT and EUS, the incidence of postoperative pathologic upstaging increases with a large TV, high TC, high TGs, high PLR, and high number of lymph nodes examined.

A study on the frequency and clinicopathological correlates of mismatch repair-deficient colorectal cancer

Microsatellite instability is an important pathway of tumorigenesis in colorectal cancer, and there is a need to understand its genetic and phenotypic profile. This study aimed to study the occurrence of deficient mismatch repair (dMMR) in an Indian cohort of patients and document the corresponding clinicopathological correlates. This is a retrospective study of patients admitted between January 2016 and December 2017. dMMR data from immunohistochemistry reports were correlated with histopathological data and demographic details. The data were then analyzed in terms of means and percentages. About 29% of cases were found to be dMMR and 66.7% of dMMR tumors occurred in males. About 44.4% of dMMR tumors occurred in the ascending colon. MSH2 loss was seen in 44.4% of cases while MLH1 loss was seen in 33.3%, and there were two cases with loss of PMS1. dMMR tumors in our study were more common in males, presented earlier, were bulky, were less likely to show lymphovascular or perineural invasion, had lower preoperative carcinoembryonic antigen levels, and yielded high number of lymph nodes. Expected differences in age, stage, and grade were not observed. Compared to other studies, a higher proportion of cases in our study had MSH2 and PMS2 loss.

Application of additive hazards models for analyzing survival of breast cancer patients.

Background:Survival rates for breast cancer (BC) are often based on the outcomes of this disease. The aim of this study was to compare the performance of three survival models, namely Cox regression, Aalen's, and Lin and Ying's additive hazards (AH) models for identifying the prognostic factors regarding the survival time of BC patients.Materials and Methods:This study was a historical cohort study which used 1025 females' medical records that underwent modified radical mastectomy or breast saving. These patients were admitted to Besat and Chamran Hospitals, Tehran, Iran, during 2010–2015 and followed until 2017. The Aalen's and Lin and Ying's AH models and also traditional Cox model were applied for analysis of time to death of BC patients using R 3.5.1 software.Results:In Aalen's and also Lin and Ying's AH models, age at diagnosis, history of disease, number of lymph nodes, metastasis, hormonal therapy, and evacuation lymph nodes were prognostic factors for the survival of BC patients (P < 0.05). In addition, in the Lin and Ying's AH model tumor size (P = 0.048) was also identified as a significant factor. According to Aalen's plot, metastasis, age at diagnosis, and number of lymph nodes had a time-varying effect on survival time. These variables had a different slope as the times go on.Conclusion:AH model may yield new insights in prognostic studies of survival time of patients with BC over time. Because of the positive slope of estimated cumulative regression function in Aalen's plot, metastasis, higher age at diagnosis, and high number of lymph nodes are important factors in reducing the survival BC, and then based on these factors, the therapists should consider a special therapeutic protocol for BC patients.

TOMM20 as a potential therapeutic target of colorectal cancer

Translocase of outer mitochondrial membrane 20 (TOMM20) plays an essential role as a receptor for proteins targeted to mitochondria. TOMM20 was shown to be overexpressed in various cancers. However, the oncological function and therapeutic potential for TOMM20 in cancer remains largely unexplored. The purpose of this study was to elucidate the underlying molecular mechanism of TOMM20’s contribution to tumorigenesis and to explore the possibility of its therapeutic potential using colorectal cancer as a model. The results show that TOMM20 overexpression resulted in an increase in cell proliferation, migration, and invasion of colorectal cancer (CRC) cells, while siRNA-mediated inhibition of TOMM20 resulted in significant decreases in cell proliferation, migration, and invasion. TOMM20 expression directly impacted the mitochondrial function including ATP production and maintenance of membrane potential, which contributed to tumorigenic cellular activities including regulation of S phase cell cycle and apoptosis. TOMM20 was overexpressed in CRC compared to the normal tissues and increased expression of TOMM20 to be associated with malignant characteristics including a higher number of lymph nodes and perineural invasion in CRC. Notably, knockdown of TOMM20 in the xenograft mouse model resulted in a significant reduction of tumor growth. This is the first report demonstrating a relationship between TOMM20 and tumorigenesis in colorectal cancer and providing promising evidence for the potential for TOMM20 to serve as a new therapeutic target of colorectal cancer.

P179 THORACOSCOPIC EXTENDED 2-FIELD LYMPH NODE DISSECTION FOR ESOPHAGEAL CANCER. IMPLEMENTATION AND SURGICAL TECHNIQUE

Abstract Aim Lymphadenectomy in minimally-invasive esophageal cancer surgery still remains challenging and standardization of surgical procedures is of extreme importance. The aim of this study is to present our safe and reproducible technique in thoracoscopic superior lymphadenectomy during esophagectomy for cancer. Background &amp; Methods In esophageal cancer surgery, dissection of the superior mediastinal lymph-nodes is of high importance. For adequate mediastinal lymph-node dissection, an extensive operating field is required along with appropriate equipment and experience. Thoracoscopy in prone position provides excellent visualization of the operative field comparing to thoracotomic phase. A step-by-step explanation of our surgical technique during thoracoscopic superior lymphadenectomy is provided. Results All patients were placed in prone position. The entire posterior mediastinal pleura was incised; azygos arch was divided with clips, facilitating dissection of the left side of the posterior mediastinum. The descending thoracic aorta was freed anteriorly, separating the esophagus; the thoracic duct was dissected and divided with vascular clips. Esophageal hiatus was dissected circumferentially and the esophageal wall was freed from the pericardiumanteriorly. Subcarinal lymph-nodes were dissected en bloc. Upper thoracic esophagus was separated from the membranous part of the trachea. The right recurrent laryngeal nerve lymph nodes were dissected at the level of the right subclavian artery, with extreme caution to avoid nerveinjury. Left recurrent laryngeal nerve was identified by posterior traction of the esophagus using a full thickness transluminal suture;by pulling it through a separate skin incision, the relative lymph nodes were dissected. Conclusion It is interesting that, higher number of lymph-nodes are harvested with this procedure which may be the result of better visualization/access. Overall, our technique has been standardized, is safe and reproducible and could be adopted by specialized Upper GI Units.

Carnoy solution versus GEWF solution for lymph node revealing in colorectal cancer: a randomized controlled trial

This study aimed to compare the performance of two lymph node revealing solutions. This randomized clinical trial (NTC02704988) investigated patients with colon or rectal cancer who underwent surgical resection with D2 lymphadenectomy. Specimens submitted for conventional pathological examination were randomly assigned for additional fixation with Carnoy or GEWF solution, and dissection was performed to examine the missed lymph nodes. The number of lymph nodes retrieved, additional identified metastatic lymph nodes, lymph node upstaging, and complementary indication of adjuvant therapy were investigated. The number of lymph nodes retrieved was significantly higher with the use of lymph node revealing solutions than with the conventional method in colon cancer (GEWF: 29.5 vs 27; p < 0.001; Carnoy: 27.7 vs 25.2; p < 0.001) and rectal cancer (GEWF: 25.8 vs 23.6; p < 0.001; Carnoy: 23.1 vs 20.8; p < 0.001). There were no differences between the solutions and conventional examination with respect to the median number of additional metastatic lymph nodes identified (0 in all arms), the number of patients with lymph node upstaging (colon cancer: 1 in the Carnoy arm, 0 in the GEWF arm; rectal cancer: 1 in the GEWF arm, 0 in the Carnoy arm), or the number of patients with complementary indication of adjuvant therapy (colon cancer: 1 in the Carnoy arm, 0 in the GEWF arm; rectal cancer: 0 in both arms). Despite the higher number of lymph nodes retrieved, neither solution resulted in significant changes in patient staging or treatment. Both solutions exhibited equal performance with respect to all outcomes. NTC02704988.

The impact of preoperative ASA-physical status on postoperative complications and long-term survival outcomes in gastric cancer patients.

The aim of this study was to investigate the impact of the preoperative American Society of Anesthesiologists-Physical status (ASA-PS) on both the short-term and long-term outcomes in patients with Gastric Cancer (GC). In a retrospective observational study, a total of 473 GC patients were divided into the following 3 groups: ASA 1, ASA 2, and ASA 3-4. The ASA 3-4 group included significantly older patients compared to the other groups (p<0.0001). In ASA 1 patients, there was a higher number of lymph nodes dissected (p=0.006), and more patients received adjuvant treatment (p<0.001). In the three groups, no difference regarding the postoperative surgical and medical complications (p=0.29 and p=0.1, respectively) nor in terms of mortality rate (p=0.17) were demonstrated. The multivariate analysis showed that age, tumor stage, number of lymph nodes dissected, positive lymph nodes, adjuvant treatments, and postoperative surgical complications were significant predictive factors for mortality. Five-year overall and disease-free survival for ASA 1, ASA 2, and ASA 3-4 groups was 56%, 57.6%, and 44%, respectively; and 37%, 44.3%, and 39.2%, respectively. Preoperative ASA-PS alone cannot serve as a direct operative risk indicator for GC patients.

A comparison of transoral vestibular and bilateral areolar endoscopic thyroidectomy approaches for unilateral papillary thyroid microcarcinomas.

IntroductionA transoral (TO) vestibular approach is a new remote access approach to avoid cutaneous scars in an endoscopic thyroidectomy (ET). And transoral endoscopic thyroidectomy (TOET) has been widely used in papillary thyroid microcarcinomas (PTMCs).AimTo evaluate and compare endoscopic thyroidectomies with central neck dissection using a bilateral areolar (BA) approach and TO approach in patients with unilateral PTMCs.Material and methodsIn total, 92 papillary thyroid cancer (PTC) patients undergoing an endoscopic unilateral thyroidectomy with central neck dissection via a TO (n = 48) or BA (n = 44) approach were retrospectively enrolled from August 2017 to December 2018. Differences in various factors, such as clinical characteristics, surgery-related parameters, including operative complications, and hospital durations and costs, were compared.ResultsNo significant between-group differences in the age and sex of the patients or the side, body mass index, total operative time, operative bleeding, superior parathyroid preservation in situ, operative complications, and postoperative day of discharge were found (all p > 0.05). The mean central neck dissection time, amount of postoperative drainage, extubation time, and inferior parathyroid preservation in situ were lower in the TO group as compared with these parameters in the BA group (all p < 0.05). The number of central lymph nodes resected and hospitalization costs were higher in the TO group as compared with those in the BA group (all p < 0.05).ConclusionsAn ET via the TO approach may be a good choice for unilateral PTMCs because of the shorter central neck dissection time, reduced postoperative drainage, better cosmetic satisfaction, and higher number of lymph nodes removed.

Main Determinants of the Extent of Lymphadenectomy in Radical Cystectomy: A Study Based on Clinical Practice

Introduction: During radical cystectomy of patients with muscle-invasive bladder cancer, pelvic lymphadenectomy is used not only for an accurate staging, but also to provide local and regional control of the disease. Although recent studies evaluating the anatomical extent of lymphadenectomy recommend an extended template, the relation between the extent of lymphadenectomy and the number of dissected nodes remains controversial. The aim of this study was to determine the main predictors of the extent of lymphadenectomy in patients with bladder cancer submitted to radical cystectomy.&#x0D; Material and Methods: Retrospective analysis of 119 patients with muscle-invasive or selected high-risk non-muscle invasive bladder cancer submitted to radical cystectomy between 2010 and 2015 at our institution.&#x0D; Results: Standard and extended lymphadenectomy was performed in 87 and 22 patients, respectively. Extended template was statistically associated with a higher number of lymph nodes dissected when compared to standard lymphadenectomy, (14 vs 11 lymph nodes; p &lt; 0.05) and showed a trend toward better overall survival, although without statistical significance (HR = 0.52, 95% CI 0.23-1.21). Extended lymphadenectomy was performed preferentially in patients undergoing an orthotopic bladder substitution (47.8%) relatively to other types of urinary diversion (around 10% - 11%). These patients had more lymph nodes dissected relatively to cutaneous ureterostomy (15 vs 8 lymph nodes), on average.&#x0D; Conclusion: The surgeon’s decision about the type of urinary diversion to be performed is the main determinant of the extent of lymphadenectomy in patients with bladder cancer undergoing radical cystectomy The number of retrieved lymph nodes was associated with the extent of lymphadenectomy and with a trend toward better overall survival.

Impact of hospital care volume on clinical outcomes of laparoscopic radical hysterectomy for cervical cancer: A systematic review and meta-analysis.

In cervical cancer, the impact of hospital volume of laparoscopic radical hysterectomy (LRH) has not been investigated systematically as in ovarian cancer.The aim of this study was to investigate the impact of hospital care volume of LRH on treatment outcomes of patients with cervical cancer. The PubMed, Embase, and Cochrane Library databases were searched with the terms "cervical cancer," "radical hysterectomy," and "laparoscopy." The selection criteria included studies presenting operative outcomes and/or perioperative complications of LRH from high-volume hospitals (HVHs) (≥15 cases/year) and low-volume hospitals (LVHs) (<15 cases/year). Fifty-nine studies including 4367 cases were selected. Linear regression analysis weighted by the average annual case number in each study was performed to evaluate differences between the groups. In HVH, a higher number of lymph nodes (24.5 vs 21.1; P = .037) were retrieved by LRH in older women (48.4 vs 44.5 years; P = .010) with tendencies of shorter operation time (224.4 vs 256.4 minutes; P = .096) and less blood loss (253.1 vs 322.2 mL; P = .080). Compared with LVH, HVH had fewer patients with stage IA disease (13.8 vs 24.4%; P = .003) and more patients with stage IIA disease (15.3 vs 7.1%; P = .052) with comparable 5-year overall survival (93.1 vs 88.6%; P = .112). HVH is a prognostic factor for operative outcome and perioperative complications in patients with cervical cancer undergoing LRH. The exact effect of hospital volume on survival outcome needs to be evaluated.

High Tie or not in Resection for Cancer in the Sigmoid Colon?

The optimal extent of mesenteric resection in colon cancer surgery remains elusive. The aim was to assess the impact on perioperative morbidity and oncological outcome depending on the height of central vessel ligation in sigmoid resection for adenocarcinomas. All cases of stage I-III sigmoid cancers, operated on with locally radical resections (2007-2009), were identified in the Swedish Colorectal Cancer Registry and categorized according to the position of the vascular ligature, that is, ligation of the inferior mesenteric artery, ligation of the superior rectal artery, or ligation of the sigmoid branches. In total, 999 cases were identified and possible to categorize. Although higher ligation level yielded a higher number of lymph nodes, 3- or 5-year overall survival, 5-year disease-free survival, or recurrence rate did not differ between the groups (p = 0.79, p = 0.41, p = 0.67, p = 0.51). No differences in survival were detected after multivariate analysis adjusted for age, sex, T-stage, N-stage, American Society of Anesthesiologists classification, and adjuvant therapy. This large population-based study showed increased lymph node yield but no survival benefit or any decreased recurrence rate by high tie in resection of sigmoid cancer.

Factors Associated With Host Immune Response and Number of Lymph Nodes: A Large Retrospective Cohort Study.

The host immune response (HIR) against tumor cells is one of the key players in antitumor activities. However, the relationship between HIR and regional lymph nodes (LN) and their impacts on prognosis have not been studied. This study analyzed HIR and clinicopathologic factors for 8819 consecutive gastric cancer patients who underwent gastrectomy and D2 LN dissection. The findings confirmed Epstein-Barr virus (EBV) with Epstein-Barr encoding region in situ hybridization, HIR grading (G1, G2, and G3), LN numbers classified into seven groups, and performed ordinal regression analysis. The mean number of LNs was 41. A higher degree of HIR was significantly associated with male sex, EBV+, non-intestinal histology by Lauren classification, earlier American Joint Committee on Cancer (AJCC) stage, and greater number of LNs (P < 0.001). Female gender, younger age (< 60years), EBV+, non-intestinal histology, higher HIR grade (G2 and G3), larger tumor size, and deeper invasion depth were significantly related to a higher number of LNs, with an odds ratio greater than 1. In cancer-specific survival analyses, EBV+, younger age, higher HIR grade (G3), and increased number of LNs were independent prognostic factors in addition to AJCC stage. The HIR was associated with increased number of LNs was a significant favorable prognosticator.

Lymph Node Radiotherapy Instead of Extended Axillary Surgery - the New Standard

Breast cancer treatment has undergone major changes in the last 20 years. Specifically, the role of axillary lymph node dissection has changed from radical axillary dissection with excision of a high number of lymph nodes to sentinel lymph node biopsy (SLNB). This paradigm shift is associated with a controversial debate regarding the significance of axillary staging, the need for surgery, and the role of radiotherapy. Looking ahead, lymph node staging and axillary treatment might shift from SLNB and/or axillary dissection to ultrasound-guided needle biopsy and irradiation of regional lymph nodes in order to reduce treatment-related sequelae in early-stage breast cancer.

Laparoscopic Versus Conventional Open Rectum Amputation: a Clinical, Intraoperative, and Short-term Outcome Comparative Study

Abstract Objective: To evaluate and compare laparoscopic and conventional open rectum amputation procedures using clinical, intraoperative, postoperative, and oncological criteria. Methods: Fifty-nine patients with lower rectal and anorectal cancer were included in a retrospective study, conducted between 2014 and 2017. Patients underwent open or laparoscopic rectum amputation surgery and were divided into two groups: group 1 – laparoscopic amputation group (LAG) and group 2 – open amputation group (OAG). The clinical, intraoperative, and postoperative outcomes and oncological results were compared between the two groups. Results: We found a significantly smaller intraoperative blood loss (325 mL vs. 538.29 mL, p = 0.0002), earlier return of bowel motility (2.41 days vs. 3.10 days, p = 0.036), shorter hospital stays (10.08 days vs. 12.66 days, p = 0.03), and a higher number of lymph nodes removed during surgery (12.33 nodes for LAG vs. 9.98 nodes for OAG, p = 0.049). In the open surgery group we found shorter durations of surgery (199.58 minutes for LAG vs. 157.87 minutes for OAG, p = 0.0046). Conclusion: Laparoscopic rectum amputation is a technically demanding procedure. The present study demonstrates the benefits and disadvantages of this surgery, with comparable clinical, intraoperative, postoperative, and oncological results compared to the conventional open rectum amputation procedure.

Function, Shoulder Motion, Pain, and Lymphedema in Breast Cancer With and Without Axillary Web Syndrome: An 18-Month Follow-Up.

Axillary web syndrome (AWS) can develop following breast cancer surgery and presents as a tight band of tissue in the axilla with shoulder abduction. The objectives were to determine the prevalence and natural history of AWS and the association between AWS and function, range of motion, pain, lymphedema, and body mass index (BMI). This study was a longitudinal prospective cohort study utilizing a repeated measures design. Axillary web syndrome, function, shoulder range of motion, pain, and lymphedema (using circumference, bioimpedance spectroscopy, tissue dielectric constant) were assessed in women at 2, 4, and 12 weeks and 18 months following breast cancer surgery. Prevalence of AWS and the association with the measured outcomes were analyzed. Thirty-six women agreed to participate in the study. The cumulative prevalence of AWS was 50% (18/36) at 18 months following breast cancer surgery. AWS was identified as a risk factor for reduced function. Women with AWS had statistically reduced range of motion, lower BMI, and higher number of lymph nodes removed compared to the non-AWS group. Forty-one percent (13/32) of women had AWS at 18 months. AWS reoccurred in 6 women following resolution, and a new case developed beyond the early postoperative period. The overall prevalence of physical impairments ranged from 66% to 97% within the first 18 months following surgery regardless of AWS. Limitations include a small sample size and potential treatment effect. AWS occurs in approximately 50% of women following breast cancer surgery. It can persist for 18 months and potentially longer, develop beyond the early postoperative time period, and reoccur after resolution. Clinicians need to be aware of the chronicity of AWS and its association with reduced range of motion and function.

WITHDRAWN: Poorer clinicopathologic features and better long-term survival in young than old patients with gallbladder cancer treated with surgical resection

// Guo-Qing Jiang 1, * , Bao-Huan Zhou 1, 3, * , Dou-Sheng Bai 1, * , Ping Chen 1 , Jian-Jun Qian 1 , Sheng-Jie Jin 1 and Hao-Jun Yang 2 1 Department of Hepatobiliary and Pancreatic Surgery, Clinical Medical College of Yangzhou University, Yangzhou, China 2 Department of General Surgery, Changzhou No.2 People's Hospital, Affiliated Hospital of Nanjing Medical University, Changzhou, China 3 Department of Hepatobiliary and Pancreatic Surgery, Dalian Medical University, Dalian, Liaoning, China * These authors contributed equally to this work Correspondence to: Hao-Jun Yang, email: HaoJunYangDoc@hotmail.com Keywords: gallbladder cancer; age at diagnosis; SEER; survival analysis; surgery Received: August 07, 2017&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Accepted: December 28, 2017&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Epub: January 02, 2018 ABSTRACT This article compares the clinical characteristics and prognosis of patients in different age groups with gallbladder cancer (GBC) treated by surgical resection. We retrospectively studied Surveillance, Epidemiology, and End Results (SEER) population-based data and identified 10,568 patients with GBC who underwent surgical treatment from 1980 to 2013. The patients were categorized according to age at diagnosis: &lt;60 years (young group) or &ge;60 years (old group). Five-year cancer-specific survival data were obtained. Kaplan&ndash;Meier methods and multivariable Cox regression models were used to analyze long-term survival outcomes and risk factors. Patients in the young group had a higher proportion of white race within-group comparisons, a higher rate of tumors at TNM stage III/IV, a higher frequency of &gt;5-cm tumors, a lower prevalence of a localized SEER stage, a higher number of lymph nodes dissected (&ge;2 nodes), and a lower proportion of tumors among patients with a widowed marital status, all of which were statistically significant within-group differences ( P &lt; 0.001). Age at diagnosis was an independent prognostic factor in the multivariate analysis ( P &lt; 0.001). The 5-year gallbladder cancer cause-specific survival rate was 26.7% in the young group and 16.2% in the old group, which showed statistical significance in both the univariate and multivariate analysis ( P &lt; 0.001). Conclusions Young patients with GBC treated with surgical resection appear to have unique characteristics and a higher cancer-specific survival rate than older patients, although they showed a higher rate of poor biological behavior and advanced-stage disease.

Three-field versus two-field lymphadenectomy for carcinoma of the middle and lower esophagus: Short-term results of a randomized controlled trial.

4036 Background: The safety and efficacy of esophagectomy with 3-field lymphadenectomy remain controversial. Methods: We did this randomized trial in Fudan University Shanghai Cancer Center in China. Between March 2013 and November 2016, 400 patients with cancer located in the middle and lower esophagus were recruited and randomly assigned to receive 3-field or 2-field lymphadenectomy at a 1:1 ratio. Postoperative complications between the 3-field group (n = 200) and 2-field group (n = 200) were compared on the basis of the intention-to-treatment principle. Results: There was no significant difference between the two arms in terms of gender, age, BMI, FEV1, and tumor location. Median operative time was 183 minutes (range 125 to 331) in 3-field group versus 168 minutes (range 116 to 375) in 2-field group, P&lt; 0.001. Overall morbidity was 28% (56/200) in the 3-field group and 30.5% (61/200) in the 2-field group, P= 0.583. The mortality rate was 0% (0/200) for the 3-field group and 0.5% (1/200) for the 2-field group, P= 1.000. Although more reintubation occurred in the 3-field group than in the 2-field group (3% [6/200] vs. 0% [0/200], P= 0.030), the distribution of severity (stratified according to the Clavien-Dindo classification) and hospital stay were similar between the two groups. A significantly higher number of lymph nodes were retrieved in the 3-field group (median 37, range 3 to 85) compared to those in the 2-field group (median 24, range 7 to 61) ( P&lt; 0.001). 44 patients (22%) had positive cervical nodes in the 3-field group. Conclusions: Morbidity after esophagectomy with 3-field lymphadenectomy is comparable with that after 2-field lymphadenectomy. Cervical lymphatic involvement is common in patients with middle and lower esophageal cancer. 3-field lymphadenectomy may offer more accurate tumor staging related to cervical lymphatic metastasis. TABLE. Regions of lymph nodes metastases Clinical trial information: NCT01807936. [Table: see text]

Impact of cervical cancer care volume on clinical outcomes of laparoscopic radical hysterectomy: A systematic review and meta-analysis.

e17013 Background: This study investigated the impact of hospital and physicain cervical cancer case volume on clinical outcomes of laparoscopic radical hysterectomy (LRH) to clarify the hypothesis that clinical outcome of cervical cancer may depend on experience of hospital and physician performing radical hysterectomy (RH). Methods: In January 2017 the PubMed search identified 556 articles. A combination of the following key words was used in the search: (cervical cancer and laparoscopy and RH) and (cervical cancer and LRH). When filtered for studies presenting operative outcomes and/or perioperative complications of LRH 59 studies including 4,367 patients met the selection criteria: high volume hospitals (HVH) (≥15 cases/year; 13 studies, 2227 patients) and low volume hospitals (LVH) (&lt;15 cases/year; 46 studies, 2140 patients); high volume physicians (HVP) (≥10 cases/year; 7 studies, 1167 patients) and low volume physicians (LVP) (&lt;10 cases/year; 35 studies, 1258 patients). Linear regression analysis which is weighted by the number of patients per year in each study was performed to evaluate differences between the groups using Stata/SE 14. Results: Analyses according to hospital volume showed following outcomes in HVH compared with LVH: tendency of lower operative time and blood loss; the higher number of lymph nodes (LN) retrieved; older age; and lower frequency of stage IA. Moreover, hospital stay, intra- and post-operative complications, adjuvant therapy, 5-year overall survival, disease free survival and recurrence rate, stage IB1, IB2, and IIA, LN metastasis, and lymphovascular space, parametrial and surgical margin invasion were not different between the groups. Analyses according to physician volume showed following outcomes in HVP compared with LVP: the higher number of LN retrieved; longer hospital stay; higher 5-year recurrence rate; and lower frequency of stage IA and surgical margin invasion. Moreover, other factors were not different between the groups. Conclusions: Higher hospital and physician volumes are associated with better operative outcomes. However, those might not be favorable prognostic factors for cervical cancer.

Potassium Channel Candidate Genes Predict the Development of Secondary Lymphedema Following Breast Cancer Surgery.

Potassium (K) channels play an important role in lymph pump activity, lymph formation, lymph transport, and the functions of lymph nodes. No studies have examined the relationship between K channel candidate genes and the development of secondary lymphedema (LE). The study purpose was to evaluate for differences in genotypic characteristics in women who did (n = 155) or did not (n = 387) develop upper extremity LE following breast cancer treatment based on an analysis of single-nucleotide polymorphisms (SNPs) and haplotypes in 10 K channel genes. Upper extremity LE was diagnosed using bioimpedance resistance ratios. Logistic regression analyses were used to identify those SNPs and haplotypes that were associated with LE while controlling for relevant demographic, clinical, and genomic characteristics. Patients with LE had a higher body mass index, had a higher number of lymph nodes removed, had more advanced disease, received adjuvant chemotherapy, received radiation therapy, and were less likely to have undergone a sentinel lymph node biopsy. One SNP in a voltage-gated K channel gene (KCNA1 rs4766311), four in two inward-rectifying K channel genes (KCNJ3 rs1037091 and KCNJ6 rs2211845, rs991985, rs2836019), and one in a two-pore K channel gene (KCNK3 rs1662988) were associated with LE. These preliminary findings suggest that K channel genes play a role in the development of secondary LE.

Does higher number of lymph nodes (LNs) excised during radical prostatectomy (RP) improve biochemical relapse-free survival (bRFS) in patients with pT2-3a/pN0 prostate cancer?

61 Background: In published series of extended pelvic LN dissection (LND), an association between higher number of LNs resected and both higher rate of occult LN disease discovery and long-term bRFS (for pN0) was observed. Despite this, practice patterns of LND extent (and associated number of LNs examined) vary, with the majority being limited to local nodal sampling. It remains unclear whether the LN yield correlates with bRFS in this context. The present investigation examines whether the number of LNs examined at RP is associated with bRFS. Methods: Patients with clinically localized prostate cancer, initial PSA &lt; 30, and pT2-3a/N0 disease at RP were retrospectively identified for inclusion. Those who received pre-RP or adjuvant radiotherapy or hormone therapy were excluded. Kaplan-Meier method was employed for survival probability estimation. Cox regression models were used to assess bRFS differences. Results: From 2002 to 2010, 672 patients were eligible for this analysis. The median age was 61 yrs (range, 43-76). Most patients had cT1c (83%), Gleason Score (GS) 4-6 (63%), and were low risk by D’Amico classification (56%), with median PSA of 5.6 ng/dL (0.9-28.0). At RP, 213 (32%) patients had positive margins (M+). At a median follow-up of 82 months, 140 patients (21%) experienced PSA failure with estimated bRFS of 81%/76% at 5/8 years. Univariate analysis identified GS ³ 7 (biopsy or RP), intermediate/high risk, M+, higher percentage of biopsy cores involved, and performance of LND as adversely associated with bRFS (all p &lt; 0.01). Of 446 patients (66%) who had LN sampling , 396 had a specific number of LNs reported (median 5; range 1-24, with single outlier case [33] excluded for statistical analysis). A higher number of LNs excised was not associated with bRFS for the entire cohort (HR = 0.99, p = 0.60), or for any biopsy GS subgroup (GS4-6 HR = 0.92, GS7 HR = 1.00, GS8-10 HR = 0.11). Conclusions: In the context of limited LND, this study did not demonstrate an association between LN yield and bRFS in patients with clinically localized pT2-3a/pN0 prostate cancer managed with RP alone, either in the entire population or with stratification by GS.