Dissection Lymph Research Articles

A Retrospective Single-Center Comparative Study Between Robot-Assisted and Laparoscopic Radical Nephroureterectomy for Upper-Tract Urothelial Carcinoma on Perioperative Results, Overall Survival, and Recurrence Rate.

Introduction Patients with localized high-risk urothelial carcinoma of the upper urinary tract are advised radical nephroureterectomy, the surgical removal of the kidney and ureter, utilizing robot-assisted versus laparoscopic methods. This study aims to compare the surgical and oncological results of robot-assisted and laparoscopic radical nephroureterectomy for upper-tract urothelial carcinoma. Methods An observational retrospective cohort study compared 14 patients who had robotic-assisted nephroureterctomy (RAN) to 16 patients who had laparoscopic assisted nephroureterctomy (LAN). Results There was no significant difference in age, sex, glomerular filtration rate (GFR), creatinine, Charlson comorbidity score, length of hospital stays, or the need to convert to an open approach. However, there was a statistical difference between the two procedures in terms of lymph dissection (p-value of 0.037) and the length of the procedure (p-value of 0.09). Conclusions The robotic approach has significantly higher use for lymph node dissection, while laparoscopic radical nephroureterectomy has a shorter operation time.

Based on 3D-PDU and clinical characteristics nomogram for prediction of lymph node metastasis and lymph-vascular space invasion of early cervical cancer preoperatively

PurposeTo develop and validate a nomogram based on 3D-PDU parameters and clinical characteristics to predict LNM and LVSI in early-stage cervical cancer preoperatively.Materials and methodsA total of first diagnosis 138 patients with cervical cancer who had undergone 3D-PDU examination before radical hysterectomy plus lymph dissection between 2014 and 2019 were enrolled for this study. Multivariate logistic regression analyses were performed to analyze the 3D-PDU parameters and selected clinicopathologic features and develop a nomogram to predict the probability of LNM and LVSI in the early stage. ROC curve was used to evaluate model differentiation, calibration curve and Hosmer-Lemeshow test were used to evaluate calibration, and DCA was used to evaluate clinical practicability.ResultsMenopause status, FIGO stage and VI were independent predictors of LNM. BMI and maximum tumor diameter were independent predictors of LVSI. The predicted AUC of the LNM and LSVI models were 0.845 (95%CI,0.765–0.926) and 0.714 (95%CI,0.615–0.813). Calibration curve and H-L test (LNM groups P = 0.478; LVSI P = 0.783) all showed that the predicted value of the model had a good fit with the actual observed value, and DCA indicated that the model had a good clinical net benefit.ConclusionThe proposed nomogram based on 3D-PDU parameters and clinical characteristics has been proposed to predict LNM and LVSI with high accuracy, demonstrating for the first time the potential of non-invasive prediction. The probability derived from this nomogram may have the potential to provide valuable guidance for physicians to develop clinical individualized treatment plans of FIGO patients with early cervical cancer.

Features and outcomes of bilateral anatomical lung resections in patients with lung cancer

The aim of this study was to evaluate the feasibility and safety of sequential bilateral anatomical lung resections performed via video-assisted thoracic surgery (VATS) or thoracotomy approaches in lung cancer patients, as well as to identify factors affecting the postoperative period. Material and Methods. Of 534 NSCLC patients undergoing anatomical lung resection in Center for Intensive Pulmonology and Thoracic Surgery from 2014 to 2022, 14 patients with consecutive bilateral anatomical lung resections were included in the retrospective study. The patients were divided into two groups depending on a surgical approach used during the first surgery: group I – 5 patients underwent thoracotomy and group II – 9 patients underwent videoassisted thoracic surgery (VATS). The groups were matched for gender, age, smoking, Charlson Comorbidity Index, lung resection, functional status and stage of the disease. Surgical treatment included anatomical lung resection and ipsilateral systematic lymph dissection. Results. There were significant differences in intraoperative blood loss between the groups. Postoperative complications after surgery on the contralateral lung were observed more often in group 1 patients than in group II patents. The overall 5-year survival rates in patients of groups 1 and 2 were 60 % and 86 %, respectively. Respiratory function indicators three months after surgery corresponded to preoperative prognosis, and their decrease did not depend on the surgical approach used. In comparison with patients who underwent standard unilateral lung resection, bilateral anatomical lung resection was not associated with increased number of “major” complications, however, an increase in the frequency of prolonged air discharge was noted (26 % vs 6 %; p<0.05). Conclusion. Sequential bilateral anatomical lung resections are feasible and safe after thorough preoperative assessment of the functional reserves of the cardio-respiratory system. Mini-invasive technologies make it possible to reduce the frequency of complications in the early postoperative period. The use of the VATS approach makes it possible to safely perform anatomical resection of the contralateral lung.

Regional Differences in Stage III Nonseminoma Germ Cell Tumor Patients Across SEER Registries

PurposeWe investigated regional differences in patients with stage III nonseminoma germ cell tumor (NSGCT). Specifically, we investigated differences in baseline patient, tumor characteristics and treatment characteristics, as well as cancer-specific mortality (CSM) across different regions of the United States. MethodsUsing the Surveillance, Epidemiology, and End Results (SEER) database (2004-2018), patient (age, race/ethnicity), tumor (International Germ Cell Cancer Collaborative Group [IGCCCG] prognostic groups) and treatment (systemic therapy and retroperitoneal lymph dissection [RPLND] status) characteristics were tabulated for stage III NSGCT patients, according to 12 SEER registries representing different geographic regions. Multinomial regression models and multivariable Cox regression models testing for cancer-specific mortality (CSM) were used. ResultsIn 3,174 stage III NSGCT patients, registry-specific patient counts ranged from 51 (1.5%) to 1630 (51.3%). Differences across registries existed for age (12%-31% for age 40+), race/ethnicity (5%-73% for others than non-Hispanic whites), IGCCCG prognostic groups (24%-43% vs. 14-24% vs. 3%-20%, in respectively poor vs. intermediate vs. good prognosis), systemic therapy (87%-96%) and RPLND status (12%-35%). After adjustment, clinically meaningful inter-registry differences remained for systemic therapy (84%-97%) and RPLND (11%-32%). Unadjusted 5-year CSM rates ranged from 7.1% to 23.3%. Finally in multivariable analyses addressing CSM, 2 registries exhibited more favorable outcomes than SEER registry of reference (SEER Registry 12): SEER Registry 4 (Hazard Ratio (HR): 0.36) and SEER Registry 9 (HR: 0.64; both P = .004). ConclusionWe identified important regional differences in patient, tumor and treatment characteristics, as well as CSM which may be indicative of regional differences in quality of care or expertise in stage III NGSCT management.

Robotic versus laparoscopic pelvic lateral lymph node dissection in locally advanced rectal cancer: a systemic review and meta-analysis.

There are few available studies that compare the feasibility, efficacy, and safety of robotic pelvic lateral lymph node dissection compared to laparoscopic pelvic lateral lymph node dissection (LPLND) in advanced rectal cancer. This meta-analysis aims to compare perioperative outcomes between robotic and LPLND. We performed a systemic literature review of PubMed, Embase, and Web of Science databases. Perioperative parameters were extracted and pooled for analysis. This meta-analysis provided an analysis of heterogeneity and prediction intervals. Five studies were included: 567 patients divided between 266 robotic and 301 LPLND. Overall operation time was longer in the robotic group than laparoscopic group (difference in means = 67.11, 95% CI [30.80, 103.42], p < 0.001) but the difference in the pelvic lateral lymph dissection time was not statistically significant (difference in means = - 1.212, 95% CI [ - 11.594, 9.171], p = 0.819). There were fewer overall complications in the robotic than in the laparoscopic group (OR = 1.589, 95% CI [1.009, 2.503], p = 0.046), especially with respect to urinary retention (OR = 2.23, 95% CI [1.277, 3.894], p = 0.005). More pelvic lateral lymph nodes were harvested by robotic surgery than by laparoscopy (differences in means = - 1.992, 95% CI [ - 2.421, 1.563], p < 0.001). In this meta-analysis, robotic pelvic lateral lymph node dissection was associated with more pelvic lateral lymph nodes harvested and lower overall complications, especially urinary retention when compared to LPLND. Further studies are needed to reinforce these findings.

Fluorescent signal lymph node mapping using indocyanine green in early breast cancer patients (Botkin Hospital experience)

Modern diagnostic methods with more accurate staging of the tumor process and effective high-tech treatment of breast cancer are very relevant, since this disease ranks first in the structure of cancer morbidity and mortality among women. Mapping of the signal lymph node is an alternative to axillary lymphatic dissection in patients with clinically intact regional lymph nodes (cN0). This allows patients to avoid such formidable, often and disabling complications of lymphatic dissection as prolonged postoperative lymphorrhea and lymphatic swelling of the upper extremity (lymphostasis). Radioisotope is the standard method of performing lymph node mapping, but recent years there have been more and more scientific studies and publications on the effectiveness of the non-toxic and non-radioisotope method in oncosurgery – fluorescent lymphography with indocyanine green.This article analyzes the experience and results of performing a mapping signal lymph node by a fluorescent method with indocyanine green at an early staged breast cancer in the Botkin Hospital, Moscow.

Abstract PO1-28-05: Preventive Microsurgery in Breast Cancer Treatment

Abstract Relevance: Breast cancer (breast cancer) ranks first among all oncological diseases in women in the world. In 2020, 2.3 million people worldwide were diagnosed with breast cancer. The most common complication after radical breast surgery is violation of lymph outflow in the form of lymphatic edema (lymphedema) of the limb. The probability of developing lymphedema according to scientific literature is from 12 to 60%. Treatment of this complication is carried out conservatively and surgically. According to a review of international experience, a preventive microsurgical technique for restoring lymph outflow from the upper limb – the application of lymphovenous anastomoses (LVA) has a positive result for the prevention of lymphedema, similar to a sentinel lymph node biopsy and can be considered as an addition to standard axillary lymph dissection (ALD). Objective: To evaluate the effectiveness of preventive microsurgical application of LVA after ALD in breast cancer. Methods: From August 2022 to June 2023, 44 operations were performed with preventive microsurgical application of lymphovenous anastomoses on the basis of the Department of Tumors of the Female Reproductive System of the Central Clinical Hospital “RZD-Medicine”, Moscow. In 39 patients, surgery was performed during the primary treatment: disease stage cT1-4N1-3M0. Organ-preserving resection with lymph node dissection (9),mastectomy with lymph node dissection (30). In 14 patients, a biopsy of the sentinel lymph node was performed at the first stage; according to the result of a lesion of 2 or more, ALD and LVA were performed. In 5 patients, ALD was performed for local recurrence of the disease in the axillary region. All patients underwent immediate microsurgical restoration of lymphatic outflow from the upper limb during one operation in the axillary region after the stage of lymph node dissection. A fluorescent dye was used for reverse mapping of lymphatic pathways from the upper limb. Isotopes + fluorescent dye were used to determine the sentinel lymph node. Lymphatic venous anastomoses were applied end-to-end, end-to-side, side-to-side and by the Optocus technique. Results: The median follow-up was 5.5 months. The duration of the operation increased by an average of 70 minutes: at the same time, the ALD time increased by an average of 14 minutes for gentle skeletization of the veins for the subsequent application of LVA. In 4 patients, the integrity of the recipient vein was damaged during lymph node dissection and restored microsurgically. No surgical complications were observed. The average duration of lymphorrhea in the postoperative period was 2.3 days (without LVA 13.9 days). Conclusions: The preventive microsurgical technique for restoring lymph drainage from the upper limb has a number of technical limitations, requires special training and microsurgical equipment. Nevertheless, the technique is safe, feasible and effective in the early postoperative period. The application of LVA led to a significant decrease in lymphorrhea in the postoperative period, a reduction in hospital stay, but an increase in the duration of the operation. Longer follow-up is required to assess the overall effect of LVA on the incidence of lymphedema. Citation Format: Vladimir Vorotnikov, Alexander Soynov, Alexander Soynov, Regina Pakhomova, Alexandra Gugnina, Sardor Abdugafforov, Sofia Kim, Tornike Mchedlidze. Preventive Microsurgery in Breast Cancer Treatment [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-28-05.

Who would be the winner? A prognostic nomogram for predicting the benefit of postoperative radiotherapy ± chemotherapy in patients with locally advanced gastric cancer: TROD-02-01 study

We aimed to develop a basic, easily applicable nomogram to improve the survival prediction of the patients with stage II/III gastric cancer (GC) and to select the best candidate for postoperative radiotherapy (RT). In this multicentric trial, we retrospectively evaluated the data of 1597 patients with stage II/III GC after curative gastrectomy followed by postoperative RT±chemotherapy (CT). Patients were divided into a training set (n=1307) and an external validation set (n=290). Nomograms were created based on independent predictors identified by Cox regression analysis in the training set. The consistency index (C-index) and the calibration curve were used to evaluate the discriminative ability and accuracy of the nomogram. A nomogram was created based on the predictive model and the identified prognostic factors to predict 5-year cancer-specific survival (CSS) and progression-free survival (PFS). The multivariate Cox model recognized lymph node (LN) involvement status, lymphatic dissection (LD) width, and metastatic LN ratio as covariates associated with CSS. Depth of invasion, LN involvement status, LD width, metastatic LN ratio, and lymphovascular invasion were the factors associated with PFS. Calibration of the nomogram predicted both CSS and PFS corresponding closely with the actual results. In our validation set, discrimination was good (C-index, 0.76), and the predicted survival was within a 10% margin of ideal nomogram. In our relatively large cohort, we created and validated both CSS and PFS nomograms that could be useful for underdeveloped or developing countries rather than Korea and Japan, where the D2 gastrectomy is routinely performed. This could serve as a true map for oncologists who must make decisions without an experienced surgeon and a multidisciplinary tumor board.

Transthoracic single-port-assisted laparoscopic gastrectomy versus laparoscopic transhiatal approach for Siewert type II adenocarcinoma of the esophagogastric junction: a single-center retrospective study.

The surgical approach for patients with Siewert type II AEG remains controversial. Several studies have described a new laparoscopic radical resection approach of Siewert type II AEG through the left diaphragm. However, the technical safety and feasibility of the new surgical approach compared with the transhiatal approach have not yet been tested. We retrospectively reviewed patients with AEG who underwent TSLG and LTH operations in the Guangdong Provincial Hospital of Chinese Medicine between January 2017 and April 2021. Histologically confirmed AEG and D2 lymphadenectomy with curative R0 patients were included, and patients with Siewert I/III AEG or distant metastasis were excluded. Blood loss, the amount of harvested lymph node, and complications related to surgery were evaluated. A total of 99 patients with Siewert type II AEG were analyzed, 44 in the TSLG group and 55 in the LTH group. There was no difference in clinicopathological features between the two groups. The more harvested lymph node (23.33±11.41 vs. 32.18±12.85, p < 0.01), lower mediastinal lymph node (1.07±2.08 vs. 3.25±3.31, p < 0.01), and longer proximal margin length (3.08±1.19 vs. 4.47±0.95cm, p < 0.01) were observed in the TSLG group. The rate of cure (R0 gastrectomy) in the TSLG group was higher than that in the LTH group (100% vs. 89.09%, p = 0.03). The TSLG approach is associated with improved surgical views, simplified lymphatic dissection in the inferior mediastinum, and more reliable margins. TSLG surgery may be an effective addition to LTH surgery, particularly when lower mediastinal lymph node metastases are suspected.

Application of carbon nanoparticles in endoscopic thyroid cancer surgery: a systematic review and meta-analysis.

There has been a substantial increase in incidence of thyroid cancer globally over the past three decades, emphasizing the necessity for efficient surgical management. Surgical intervention requires meticulous lymphatic dissection; however, it is challenging to both accurately identify lymph nodes and preserve the surrounding structures. We investigated the role of carbon nanoparticles in endoscopic thyroid cancer surgery to improve surgical effects and reduce postoperative complications. Chinese and English literature databases from inception to May 2023 were searched based on inclusion criteria, and data were extracted independently by two investigators. STATA software was used for data analysis. A comprehensive systematic review and meta-analysis were conducted with 13 publications (9 randomized and 4 non-randomized controlled trials). The results demonstrated that the application of carbon nanoparticles in thyroid surgery led to an increase in the number of retrieved lymph nodes and identification of metastatic lymph nodes. Furthermore, it considerably reduced the rate of improper parathyroidectomy and the incidence of postoperative hypocalcemia. The application of carbon nanoparticles can effectively improve the effects of surgical treatment, can enhance the identification of intraoperative lymph nodes, reduce postoperative complications, and protect the integrity and function of the parathyroid gland. www.crd.york.ac.uk/PROSPERO, identifier, CRD42023420504.

Evaluation of the diagnostic value of Sentinel Lymph Node in patients with gastric adenocarcinoma.

Sentinel lymph node biopsy (SLNB) has been proven as a safe and efficient procedure in some cancers like breast cancer and melanoma with a reduction of complications and side effects of unnecessary lymphadenectomy in many patients. However, the diagnostic value of SLNB in gastric cancer is a point of debate. This study evaluated the diagnostic value of SLNB using radiotracer and isosulphan blue dye injection in patients with Gastric Adenocarcinomas (GA). This descriptive study was performed at Imam-Reza HOSPITAL on 39 patients diagnosed with GA with no lymphatic metastasis using two methods: the combination of radionuclide with isosulphan together (R&I) method compared with the isosulphan alone method. Lymphatic dissection was performed in all patients. The pathological results were compared between the sentinel lymph nodes (SLN) and other lymph nodes and their accordance rate was calculated. In the T1 group, the sentinel lymph node biopsy detection rate was 100% for the combination of the R&I method and 60% for the isosulphan method and the false negative rate was zero. These values respectively were 88.8% and 88.8% in the T2 group with a false negative rate of 75%. In the T3 group, the values were 100% for the combination of the R&I method and 93.7% for the isosulphan method with a false negative rate of 40%. In the combination of the R&I method, the sensitivity, specificity, and positive and negative predictive values were 57.9, 100, 100, and 69.2 percent respectively. Based on the false negative rate (47.4%), SLNB by injection of isosulphan blue dye alone is not a diagnostic enough value for predicting lymph node metastasis in GA. Although, SLNB by combination of the R&I had better accuracy compared to the isosulphan alone, more studies with larger samples are needed to prove this result.

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.

Impact of tumor stage and neoadjuvant chemotherapy in fluorescence-guided lymphadenectomy during laparoscopic gastrectomy for gastric cancer: A propensity score-matched study in a western center

BackgroundThe use of indocyanine green fluorescence has been shown to be a safe and effective method for improving lymph node retrieval in patients with gastric cancer. However, previous studies have focused on early-stage tumors and/or the Asian population and excluded patients who received neoadjuvant treatment. MethodsIn this study, 142 patients with gastric adenocarcinoma underwent laparoscopic gastrectomy at a Spanish hospital between January 2017 and December 2022. Of these, 42 patients received preoperative indocyanine green injection to guide lymphadenectomy. Their outcomes were compared to a retrospective cohort of 42 patients after 1:1 propensity score matching. ResultsThe feasibility of indocyanine green lymphatic mapping was 95.5%. No complications associated with indocyanine green injection were observed. The indocyanine green group had a significantly higher number of retrieved lymph nodes than the non-indocyanine green group (32.67 vs 25.14; P = .013). This statistically significant difference was maintained across subgroups of neoadjuvant treatment, non-obese patients, pT0 to 2 stage, and pN0 stage. In 47.6% of patients from the indocyanine green group, lymphadenectomy was extended outside the standard D2 dissection area based on indocyanine green uptake, but none of the retrieved lymph nodes were metastatic. There were no differences in postoperative complications and length of hospital stay between the 2 groups. ConclusionIndocyanine green-guided lymphadenectomy is safe and feasible and increases the number of retrieved lymph nodes compared to conventional lymphatic dissection, as well as in patients receiving neoadjuvant chemotherapy. The use of indocyanine green should be routine if available for guiding lymph node dissection in gastric cancer, regardless of tumor stage or previous neoadjuvant treatment. However, further studies are needed to determine the impact of this technique on disease-free and overall survival.

Modern approaches to esophageal squamous cell carcinoma therapy: paradigm shift?

Esophageal cancer (EC) is one of the most aggressive malignant neoplasms, ranking sixth among oncological causes of death. According to GLOBOCAN, more than half a million people die from this disease every year, and by 2040 this indicator is expected to increase almost twice. In most patients, esophageal cancer is diagnosed at stages III–IV of the disease. Currently, the standard of treatment for inoperable patients with EC is simultaneous chemoradiotherapy.One of the main methods of treatment of patients with non-metastatic esophageal lesion remains surgical intervention in the volume of esophagectomy with radical lymph dissection, accompanied by quite frequent serious postoperative complications. However, the results of surgical treatment of locally advanced esophageal cancer alone remain unsatisfactory, and the fiveyear survival rate is less than 20 %. In order to improve the oncological results of treatment, various combinations of drug and radiation therapy are used (preoperative chemotherapy or chemoradiotherapy, independent chemoradiotherapy). To date, recommendations for the treatment of locally advanced esophageal cancer vary from country to country. Trimodal therapy (preoperative chemoradiotherapy up to TFD – 46 Gy with 5 cycles of weekly chemotherapy according to the carboplatin + paclitaxel scheme followed by surgical treatment) is the standard in operable patients with non-metastatic squamous cell carcinoma of the esophagus in our and European countries. In Asian countries, preference is given to neoadjuvant chemotherapy, based on the data of the JCOG1109 (NExT) study, in which it was shown that the addition of docetaxel to neoadjuvant therapy with cisplatin and fluorouracil is accompanied by an improvement in overall survival and acceptable toxicity, compared with the CF regimen and chemoradiotherapy. A separate issue is the place of lifesaving esophagectomy in patients who have received a course of radical chemoradiotherapy. Unfortunately, according to several researchers, recurrent or persistent esophageal cancer remains an urgent problem with a risk of relapse of the disease in up to 60 % of cases.We have studied the data of the Russian and global literature concerning the treatment of squamous cell carcinoma of the esophagus.

Гостро кровоточивий рак шлунка, ускладнений перфорацією

покращення та оптимізація діагностики та лікування ускладнень раку шлунка.Було проліковано 56 пацієнтів із ускладненим раком шлунка. Середній вік хворих становив56 років. З них жінок було 13 (або 23,21%), а чоловіків – 43 (або 76,79%). Під час всебічногодіагностично-лікувального моніторингу було виявлено, що 15 пацієнтів (або 26,79%) страждаливід шлунково-кишкової кровотечі, 12 пацієнтів (або 21,43%) мали стеноз шлунка різного ступеняважкості, а у решти 29 пацієнтів (або 51,79%) рак шлунка ускладнився перфорацією шлунка,при цьому у 21 пацієнта перфорація виливалася в кровотечу. Досліджували також вік, стать,передопераційну діагностику, місцезнаходження перфорації, глибину інвазії стінки шлунка,наявність метастазів у лімфатичних вузлах, вид операції, рівень лімфатичної диссекції, стадіюта інші ускладнення. Відсоток ускладнення у вигляді перфорації серед раку шлунка становив51,79%. Захворювання частіше зустрічалося на III/IV стадії (70%). Проведені операції:гастректомія у 16 хворих та атипова резекція зони ураження шлунка з відновленням дефектуу 10 пацієнтів. Смерть, пов’язана з хірургічним втручанням, спостерігалася у 4 пацієнтів.Було виконано 10 субтотальних гастректомій і 6 тотальних гастректомій. У 15 пацієнтівспостерігалася клінічно виражена шлунково-кишкова кровотеча, яка проявлялася у виглядімелени, гематемезису або у вигляді мелени та гематемезису одночасно (2,5%). Середнійвік становив 68 ± 12 (діапазон 47–87). Ускладнення у вигляді стенозу шлунка було виявлено у12 пацієнтів (21,43%). Під час дослідження у 5 пацієнтів було виявлено субкомпенсованийстеноз пілоричного відділу шлунка, у решти пацієнтів – декомпенсований стеноз. Вибір методуоперативного втручання проводився індивідуально, залежно від стану хворого, ступеня стенозуі характеру патоморфологічних змін, стану секреторної та моторної функції шлунка, наявностісупупровідньої патології та стадії раку шлунка. Перевагу надавали субтотальній резекціїшлунка. У цій групі пацієнтів наявний 1 випадок летальності, який був обумовлений ІV стадієюраку шлунка та декомпенсованим стенозом з вираженими розладами водно-електролітногобалансу і кислотно-лужної рівноваги.

THE EFFECT OF THE EXTENT OF SURGERY AND LYMPH NODE DISSECTION ON THE DEVELOPMENT OF METACHRONOUS PERITONEAL DISSEMINATION IN GASTRIC CANCER

Relevance:Metachronous peritoneal dissemination (MPD) is among the top factors in the structure of gastric cancer (GC) progression, considerably worsening radical surgery outcomes. Since cancer cell dissemination in the peritoneal cavity is often triggered during surgery, assessing its role in MPD development is important.&#x0D; The study aimed to assess the effect of the extent of radical surgery and lymph node dissection on the MPD development in radically operated gastric cancer patients.&#x0D; Methods: The results of radical surgery performed on 1080 patients with gastric cancer (рТ1-4N0-3M0) without spreading to the esophagus were assessed (647 males and 433 females) depending on the extent of surgical treatment (proximal/distal subtotal gastric resection (SGR), n=639/gastrectomy (GE), n=334; standard/combined surgery, n=973/107) and the extent of lymph node dissection (LD) – D1 (n=151) or D2 (n=929). Also assessed were survival rates (Kaplan-Meyer multiplier estimation method), cumulative incidence (CI) of competing events –MPD, metastases of other localizations, and mortality cases unrelated to gastric cancer (competing risks analysis).&#x0D; Results: The analysis showed a statistically significant increase in the cumulative incidence of GC progression after combined operations (55.6±4.9%) as compared with the standard radical treatment (GE – 42.3±2.7%, SRG – 25.6±1.7%, respectively), including an increase in MPD CI in each of applied surgical procedures (after combined operations – 36.8±4.7%, after standard GE – 21.6±2.3% and SRG – 11.1±1.2%, respectively; рGray&lt;0.001). In the presence of lymphohematogenous metastases of other localizations, the relevant figures were 9.4±2.9% after combined operations, 9.3±1.6% after standard GE, and 5.0±0.9% after SRG (рGray=0.022). Lymph node metastases increased MPD CI after LD D1 from 8.3±2.8% (pN0) to 29.1±6.2% (рN1-3) (рGray&lt;0.05), those after LD D2 increased from 9.4±1.3% (pN0) to 27.3±2.1% (рN1-3) (рGray&lt;0.05).&#x0D; Conclusion: It is advisable to assess the extent of the planned surgical treatment and the condition of local lymph nodes when evaluating the probability of MPD development. The applied lymph dissection procedure did not affect the cumulative incidence of GC progression, including MPD development.

Bronchial oncocytic carcinoma in an adult: a case report and literature review

BackgroundLung salivary-type tumors originating from bronchial submucosal glands are rare, only four types of salivary gland-type tumors are listed in 2015 WHO classification of lung tumors. Here, we report a rare case of oncocytic carcinoma (OC) in the right main bronchus.Case presentationA 34-year-old man presented to our hospital with a two-month history of recurrent hemoptysis and with one month of inspiratory dyspnea. Pulmonary function tests showed mild restrictive ventilatory dysfunction and severe diffusion dysfunction. Furthermore, the flow volume loop showed a variable extra-thoracic obstruction. Computed tomography (CT) of the chest revealed that a polypiform nodule of 13 mm in diameter was at the proximal right main bronchus. Testing for purified protein derivative was positive (category 2). The nodule was resected under bronchoscopy. The bronchial aspirate was negative for mycobacterium tuberculosis and tumor cells. The biopsy sample showed a solid and acinar predominant pattern with abundant eosinophilic cytoplasm. The bronchial mucosa was destroyed and replaced by tumor cells. The loose edematous stromal reaction could be seen in a local area. Immunohistochemically, tumor cells were positive for CK, EMA, Vimentin, CD117, CK7, S100, Mammaglobin and SOX10. Only scattered tumor cells were stained by basal cell markers, including CK5/6, P40 and P63. Electron microscopy revealed numerous swelling mitochondria with lacking mitochondrial cristae in tumor cells. Fluorescence in situ hybridization (FISH) testing for MAML2 and ETV6 rearrangement were negative. Next-generation sequencing analysis of 520 genes in the tissue biopsy specimen showed no somatic mutation. The diagnosis of OC was made. Subsequently, the patient underwent a right upper lobectomy with sleeve resection of the main bronchus and lymph dissection. No recurrent evidence was seen during two years of chest CT follow-up.ConclusionsTo our knowledge, this is the first case of primary OC in the bronchus. This patient has no recurrence during two years of follow-up, indicating that primary OC in the bronchus has the same favorable prognosis as in salivary glands. Moreover, complete excision and thorough sampling to know the invasive growth pattern is important to reach the correct diagnosis.

THE EFFECT OF THE EXTENT OF SURGERY AND LYMPH NODE DISSECTION&#x0D; ON THE DEVELOPMENT OF METACHRONOUS PERITONEAL DISSEMINATION&#x0D; IN GASTRIC CANCER

Relevance: Metachronous peritoneal dissemination (MPD) is among the top factors in the structure of gastric cancer (GC) progression,&#x0D; considerably worsening radical surgery outcomes. Since cancer cell dissemination in the peritoneal cavity is often triggered during surgery,&#x0D; assessing its role in MPD development is important.&#x0D; The study aimed to assessment of the effect of the extent of radical surgery and lymph node dissection on the MPD development in radically&#x0D; operated gastric cancer patients.&#x0D; Methods: The results of radical surgery performed on 1080 patients with gastric cancer (рТ1-4N0-3M0) without spreading to the esophagus&#x0D; were assessed (647 males and 433 females) depending on the extent of surgical treatment (proximal/distal subtotal gastric resection (SGR),&#x0D; n=639 / gastrectomy (GE), n=334; standard/combined surgery, n=973/107) and the extent of lymph node dissection (LD) – D1 (n=151) or D2&#x0D; (n=929). Also assessed were survival rates (Kaplan-Meyer multiplier estimation method), cumulative incidence (CI) of competing events –&#x0D; MPD, metastases of other localizations, and mortality cases unrelated to gastric cancer (competing risks analysis).&#x0D; Results: The analysis showed a statistically significant increase in the cumulative incidence of GC progression after combined operations&#x0D; (55.6±4.9%) as compared with the standard radical treatment (GE – 42.3±2.7%, SRG – 25.6±1.7%, respectively), including an increase in&#x0D; MPD CI in each of applied surgical procedures (respectively after combined operations – 36.8±4.7%; after standard GE – 21.6±2.3% and&#x0D; SRG – 11.1±1.2% (рGray&lt;0.001)). In the event of the presence of lymphohematogenous metastases of other localizations, the relevant figures&#x0D; were 9.4±2.9% after combined operations, after standard GE and SRG – 9.3±1.6%, 5.0±0.9% respectively (рGray=0.022). The presence of&#x0D; lymph node metastases led to an increase in MPD CI after LD D1 from 8.3±2.8% (pN0) to 29.1±6.2% (рN1-3) (рGray&lt;0.05), those after LD&#x0D; D2 increased from 9.4±1.3% (pN0) to 27.3±2.1% (рN1-3) (рGray&lt;0.05).&#x0D; Conclusion: It is advisable to assess the extent of the planned surgical treatment and the condition of local lymph nodes when evaluating&#x0D; the probability of MPD development. The applied lymph dissection procedure did not affect the cumulative incidence of GC progression,&#x0D; including MPD development.

Membrane anatomy-based radical resection for esophageal cancer

Radical resection of gastrointestinal tumors based on the membrane anatomy theory has significantly reduced the postoperative recurrence rate and improved the surgical efficacy. However, the theory of membrane anatomy has not been widely adopted in radical surgery for esophageal cancer. Our study found that the esophagus also has a membranous anatomical structure. As a foregut organ, the esophagus also has a mesenteric structure, and there is also a fifth metastasis pathway within the esophageal mesentery for esophageal cancers. The leak and metastasis of cancer caused by destruction of the mesenteric integrity may be the fundamental reason for the high postoperative recurrence rate. Using the nano carbon and indocyanine green fluorescence tracing technique, we demonstrated the lymphatic drainage of the upper esophageal segment to the left gastric artery mesenteric lymph nodes. Therefore, in the radical resection of esophageal cancer, we used the membrane anatomy theory for guidance to completely remove the esophageal cancer, esophageal mesentery, left gastric artery and its mesentery, as well as all structures within the mesentery, preventing the spread of cancer cells through the blood vessels, lymphatic system, and mesentery, and improving the efficacy and prognosis. This article elaborates on the theoretical basis of the anatomical structure of the esophageal membrane, embryonic development, imaging, autopsy, and endoscopic observation of the structure, as well as the application effect of the esophageal membrane anatomical theory in esophageal cancer radical surgery. It elucidates the anatomical structure of the esophageal membrane and the lymphatic drainage characteristics of esophageal cancer, reveals the law of lymphatic metastasis in esophageal cancer, optimizes lymphatic dissection strategies, and improves the efficacy of esophageal cancer radical surgery.

Risk factors for postoperative cognitive dysfunction in elderly patients undergoing surgery for oral malignancies

We aimed to analyse postoperative cognitive dysfunction (POCD) incidence and risk factors in elderly adults who underwent surgery for oral malignancies. A total of 112 elderly patients (aged ≥ 55 years) were selected for expanded resection of oral malignancy and cervical lymphatic dissection at our institution from December 2020 to December 2021. Participants were cognitively evaluated using the neuropsychological test scale 1 day before and 7 days after surgery to determine whether they had developed POCD. Based on whether POCD occurred 7 days after surgery, patients were classified into the POCD and non-POCD groups. Logistic regression was applied to perioperative factors to analyse the risk factors for POCD onset. Seven days after surgery for oral malignancy, there were 37 (33.1%) POCD morbidities. Multiple factor logistic regression analysis revealed that venerable age (odds ratio [OR] = 1.269, 95% confidence interval [CI] 1.056–1.525, P < 0.05), low education levels (OR = 0.792, 95% CI 0.644–0.974, P < 0.05), hypertension (OR = 4.153, 95% CI 1.335–12.732, P < 0.05), dyssomnia (OR = 1.272, 95% CI 1.001–1.617, P < 0.05), prolonged anaesthesia (OR = 1.009, 95% CI 1.001–1.018, P < 0.05), and intraoperative hypotension (OR = 5.512, 95% CI 1.240–24.506, P < 0.05) increased the POCD risk in elderly patients who underwent surgery for oral malignancies. Venerable age, low knowledge reserve, hypertension, dyssomnia, prolonged anaesthesia, and intraoperative hypotension are independent risk factors for POCD in elderly patients with oral malignancies.