Lymph Node Dissection In Patients Research Articles

Surgical Outcomes of da Vinci Xi™ and da Vinci SP™ for Early-Stage Endometrial Cancer in Patients Undergoing Hysterectomy

Objectives: This study aimed to evaluate and compare the feasibility and outcomes of two robotic hysterectomy (da Vinci Xi™ vs. da Vinci SP™) systems without lymph node dissection in patients with early-stage endometrial cancer, and assess the postoperative recurrence rate and overall survival of patients. Methods: A retrospective review of 84 patients who underwent robotic hysterectomy for endometrial cancer (stage 1A) was conducted. Surgical procedures, patient characteristics, intraoperative measures, and postoperative outcomes were statistically analyzed. A single gynecologist performed all surgeries. Results: Patient characteristics, average age, and body mass index showed no significant differences between the two models. The total operative time was significantly shorter with da Vinci SP™. Recurrence was identified in only one patient operated on with da Vinci Xi™. All patients were alive during analysis, with a median overall survival of 38 and 9 months for da Vinci Xi™ and da Vinci SP™, respectively. Conclusions: Robotic hysterectomy without lymph node dissection appears to be a safe and effective approach for patients with early-stage endometrial cancer. The da Vinci SP offers the advantage of shorter operative times than the da Vinci Xi™. These findings support the consideration of robotic surgery as a viable option for selected patients.

Abstract PO3-22-09: Implementation of nanoparticle-assisted axillary staging: reduced axillary intervention for patients with node-positive breast cancer following neoadjuvant therapy

Abstract Background: Nanoparticle-assisted axillary staging (NAAS), which combines carbon nanoparticles with standard dual-tracer (radioisotope and blue dye) sentinel lymph node biopsy (SLNB), has shown excellent results in patients undergoing neoadjuvant therapy (NAC) for pre-NAC node-positive breast cancer. This pilot study aimed to explore the possible expansion of indications (pre-NAC cN2, and cN3 stages; ycN+ stage) for NAAS, which was the first attempt till now for patients undergoing NAC, and to select specific post-NAC individuals who might be exempt from axillary lymph node dissection (ALND), especially those with relatively low tumor burdens, such as ITCs and micrometastases. Method: The medical records of all consecutive patients with breast cancer were prospectively collected from the Breast Center, West China Hospital. Patients with invasive, pre-NAC node-positive breast cancer who underwent NAAS followed by ALND between April 2021 and February 2023 were included. The detection rate (DR), average number of sentinel or NAAS nodes, false negative rate (FNR), negative predictive value (NPV), and NAAS accuracy were assessed. Subgroup analyses according to different pre- and post-NAC cN stages, especially the pre-NAC cN2-3 stages and the post-NAC cN+ stages, which were not the focus of previous studies, were conducted using crosstabs. To screen possible patients who might exempt ALND, we focus on relationships between the status of axillary lymph nodes and the number or tumor burden of NAAS nodes. Results: A total of 241 eligible patients were included in the study. There were 153 (63.49%), 40 (16.60%), and 48 (19.92%) patients in pre-NAC cN1, cN2, and cN3 stages, respectively. The post-NAC stages of patients were not restricted, 38.17% (92/241) of them converted to ycN0 stages, while 61.83% (149/241) were still in ycN+ stages. A total of 232 (96.27%) eligible patients successfully underwent NAAS; the DR, NPV, accuracy, and FNR of NAAS were 96.27%, 95.97%, 97.84%, and 4.42%, respectively. Additionally, NAAS showed accuracies of 97.30% and 93.02% and FNRs of 7.14% and 9.09% in patients with pre-NAC cN2 and cN3 breast cancers, respectively. There was no statistical difference among the FNRs of NAAS in the pre-NAC cN1, cN2, and cN3 stages (p=0.134). Moreover, NAAS yielded FNRs of 0.00% in the ycN0 population and 6.02% in the ycN+ population, respectively (p=0.323). Accuracies reached 100.00% and 96.48% in ycN0 and ycN+ patients, respectively (p=0.159). Notably, patients with one NAAS node with ITC or micrometastasis in the entire population showed no further positive disease at ALND. Conclusion: NAAS showed excellent and stable performance with a low FNR and high accuracy, indicating valuable application prospects in patients with breast cancer who received NAC. Patients with pre-NAC cN2-3 stages also have a chance to undergo NAAS, and the application of NAAS appears to be feasible regardless of the ycN stage. Especially for ycN0 population, there is no chance for NAAS to miss positive axillary lymph nodes. In addition, patients who had one NAAS node with ITC or micrometastasis might avoid ALND. Diagnostic performance of nanoparticle-assisted axillary staging in pre-neoadjuvant chemotherapy cN1, cN2 and cN3 patients Diagnostic performance of nanoparticle-assisted axillary staging in ycN0 and ycN+ patients Additional axillary disease at axillary lymph node dissection in patients with positive NAAS nodes after neoadjuvant chemotherapy XX- XX XX- XX XX- XX Citation Format: Ruixian Chen, Tao He, Jiqiao Yang, Shan Lu, Yunhao Wu, Chihua Wu, Ruoning Yang, Weijing Liu, Ya Huang, Xiangyue Meng, Xin Zhao, Qintong Li, Xin Sun, Jing Jing, Jie Chen. Implementation of nanoparticle-assisted axillary staging: reduced axillary intervention for patients with node-positive breast cancer following neoadjuvant therapy [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 PO3-22-09.

De-escalation of axillary treatment in the event of a positive sentinel lymph node biopsy in cT1-2 N0 breast cancer treated with mastectomy: nationwide registry study (BOOG 2013-07).

Trials have demonstrated the safety of omitting completion axillary lymph node dissection in patients with cT1-2 N0 breast cancer operated with breast-conserving surgery who have limited metastatic burden in the sentinel lymph node. The aim of this registry study was to provide insight into the oncological safety of omitting completion axillary treatment in patients operated with mastectomy who have limited-volume sentinel lymph node metastasis. Women diagnosed in 2013-2014 with unilateral cT1-2 N0 breast cancer treated with mastectomy, with one to three sentinel lymph node metastases (pN1mi-pN1a), were identified from the Netherlands Cancer Registry, and classified by axillary treatment: no completion axillary treatment, completion axillary lymph node dissection, regional radiotherapy, or completion axillary lymph node dissection followed by regional radiotherapy. The primary endpoint was 5-year regional recurrence rate. Secondary endpoints included recurrence-free interval and overall survival, among others. In total, 1090 patients were included (no completion axillary treatment, 219 (20.1%); completion axillary lymph node dissection, 437 (40.1%); regional radiotherapy, 327 (30.0%); completion axillary lymph node dissection and regional radiotherapy, 107 (9.8%)). Patients in the group without completion axillary treatment had more favourable tumour characteristics and were older. The overall 5-year regional recurrence rate was 1.3%, and did not differ significantly between the groups. The recurrence-free interval was also comparable among groups. The group of patients who did not undergo completion axillary treatment had statistically significantly worse 5-year overall survival, owing to a higher percentage of non-cancer deaths. In this registry study of patients with cT1-2 N0 breast cancer treated with mastectomy, with low-volume sentinel lymph node metastasis, the 5-year regional recurrence rate was low and comparable between patients with and without completion axillary treatment.

The prognostic value of lymph node dissection in patients with parathyroid carcinoma.

Surgery is the only curative treatment strategy for parathyroid carcinoma (PC). However, the optimal extent of surgery remains uncertain, particularly regarding whether routine central lymph node dissection (LND) confers a survival advantage to patients with PC. This study aimed to evaluate the prognostic value of LND in PC patients. Patients diagnosed with PC between 2004 and 2018 were identified in the Surveillance, Epidemiology, and End Results (SEER)-18 registries. With inclusion and exclusion criteria, a total of 338 patients were included as cohort 1 to describe the characteristics of PC, while 215 patients were selected as cohort 2 to assess the effect of LND on cancer-specific survival (CSS). Univariate and multivariate Cox proportional hazards regression models were used to identify independent risk factors associated with CSS. Propensity score matching (PSM) was performed to adjust for potential confounding variables. The prognostic value of LND was further analyzed in subgroups stratified by predictors associated with CSS. The 5- and 10-year CSS were 94.4% and 87.9% respectively in cohort 1. LND failed to significantly improve CSS in the entire cohort 2 and the PSM cohort 2. Large tumor size (>40 mm) and distant metastasis were independently associated with poor CSS. Subgroup analyses revealed that LND was not significantly associated with improved CSS in patients with aggressive PC, such as those with a tumor size greater than 40 mm. Unexpectedly, LND may compromise CSS in patients with distant disease (P=0.03). PC is a rare and indolent endocrine malignancy. The presence of large tumors and distant metastases are independent predictors of poor CSS. Routine central LND as part of initial surgery does not significantly improve CSS in PC patients, even for those with large tumors, lymph node metastasis, or distant disease.

Current approach to pediatric differentiated thyroid cancer.

Differentiated thyroid cancers (DTC) is a rare cancer in children and adolescents, having features of different clinical presentation, biological behavior, and treatment from adult population. Most of the patient management guidelines are based on literature on adult population and the literature on children and adolescents still limited. There are still unsettled issues regarding both patient management and the therapy. However, the current approach for treatment of DTC includes thyroidectomy, lymph node dissection in patients with nodal metastases and possible use of Iodine-131 radiotherapy. The incidence of DTC is low in pediatric population, and the characteristics of the disease vary among different age groups within this population. Therefore, the literature depends on small cohorts and heterogeneous retrospective studies. This paper aims to review the current literature and give an overview to the approach in the management of DTC in pediatric population. DTC in pediatric population, has an aggressive nature, however the patient's overall survival is excellent. A multidisciplinary approach in the management of pediatric DTC patients would yield fewer side effects and a better life quality.

Abstract 2394: Significance of regional lymph node dissection in patients with clear cell sarcoma and epithelioid sarcoma

Abstract Objective Clear cell sarcoma (CCS) and epithelioid sarcoma (ES) are common as soft-tissue sarcoma subtypes causing lymph node metastasis (LNM), but the role of regional lymph node dissection is still unclear especially in these patients without imaging evidence of LNM. Here we retrospectively investigated the significance of lymph node dissection for patients with CCS and ES. Methods Forty-one patients (CCS: 13, ES: 28) with no distant metastasis other than in the regional lymph nodes were enrolled in this study. Of these 41 patients, those without LNM on imaging findings were categorized into two groups: "with dissection (WD)" group and "no dissection (ND)" group, respectively. Overall survival (OS), lymph node metastatic-free survival (LNMFS), progression-free survival (PFS), and post-operative LNM rate were compared between two groups. Results There were 26 patients who had undergone regional lymph node dissection and 15 patients who had not undergone regional lymph node dissection (ND group). Histopathological examination revealed metastasis to the lymph nodes in 9 of the 26 patients (38.5%). 9 patients were suspected of having LNM based on preoperative imaging findings such as CT or FDG PET/CT. Among the remaining 17 patients (WD group) in whom LNM was not suspected based on preoperative imaging findings, 6 patients (35.3%) had LNM. OS (p=0.03), LNMFS (p<0.01), and PFS (p<0.01) were all significantly better in the WD group. The postoperative LNM rate was significantly lower in the WD group than in the ND group (p=0.03), and there were no significant differences in OS, LNMFS, or PFS between the CCS and ES groups in terms of histological type. Discussion Even in cases where LNM was not suspected on preoperative imaging, LNM was present in more than 30% of cases. The possibility of regional LNM should be borne in mind in soft-tissue sarcomas, which frequently present with LNM, regardless of imaging findings. We also suggested that simultaneous dissection of the regional lymph nodes at the time of resection of the primary tumor improves the prognosis. Although ES and CCS are ultra-rare sarcomas, further validation with the accumulation of case series is desirable. Citation Format: Toshiyuki Takemori, Eisuke Kobayashi, Shintaro Iwata, Koichi Ogura, Shuhei Osaki, Suguru Fukushima, Akira Kawai. Significance of regional lymph node dissection in patients with clear cell sarcoma and epithelioid sarcoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2394.

Safe suprapancreatic lymph node dissection for gastric cancer with ectopic common hepatic artery.

Suprapancreatic lymph node dissection for patients with gastric cancer in whom the common hepatic artery is located neither at the suprapancreatic margin nor in front of the portal vein is a more difficult procedure than when the common hepatic artery is in a more typical position. There is an increased risk of injury to the vessels that need to be preserved and inadequate lymph node dissection. Measures that have been reported for use in this situation are preoperative diagnosis with three-dimensional computed tomography angiography, dissection using the portal vain as a guide, and safe exposure of the portal vein with dissection to preserve the nerves at the suprapancreatic margin and in front of the portal vein. We review the literature and report our experience with a patient whose common hepatic artery was not located in the suprapancreatic margin who safely underwent suprapancreatic lymph node dissection using these methods.

Preventive central neck lymph node dissection as a stage in the treatment of papillary thyroid cancer

Relevance: The need of prophylactic cervical lymph node dissection for the detection of low grade thyroid cancer remains debatable since preoperative examination does not always allow determining the involvement of a group VI regional lymph collector.Objective: to evaluate the frequency of group VI nodes involvement with clinical N0–Nx based on the results of a morphological examination after performing a preventive central neck lymph node dissection.Materials and methods: the study included 295 patients who underwent surgery from 2016 to 2022 for papillary thyroid cancer with cT1–T2, N0–Nx. There were 11.5 % of men included (n = 34) and 88.5 % of women (n = 261). Of these, 40.7 % (n = 120) were less than 55 years old. All patients underwent surgical treatment which included thyroidectomy or hemithyroidectomy with cervical lymph node dissection.Results: The study included 295 patients with cT1 — 247 (83.7 %) and cT2 — 48 (16.3 %). Pathomorphological examination changed the T index in some patients: pT1 was found in 80.3 % of cases (n = 237); рТ2 — in 9.2 % (n = 27); рТ3 — in 10.5 % (n = 31). Central neck lymph nodes involvement was detected in 77 (26.1 %) out of 295 patients. There was a correlation between the frequency of metastases detection and the size of the primary tumor: 22.8 % (n = 54) of metastases with pT1, 33.3 % (n = 9) with pT2, and 45.2 % (n = 14) with pT3. Transient hypocalcemia was found in 32 % of patients with pT1, 69 % with pT2, and 84 % with pT3. Two patients had unilateral transient paresis of the larynx.Conclusions: Our analysis demonstrates that the preventive central neck lymph node dissection in patients with low grade thyroid cancer is an important component of surgical treatment, which allows to improve the treatment results with a possible subsequent reduction in the risk of distant progression. In this study 77 (26.1 %) of 295 patients had metastases in the lymph nodes of the central neck. The number of postoperative complications affecting the quality of life of patients was acceptable with 0.67 % of paresis of the larynx and 39 % of mild hypocalcemia.

Robot-assisted minimally invasive esophagectomy versus minimally invasive esophagectomy for thoracic lymph node dissection in patients with squamous cell carcinoma: a retrospective comparative cohort study.

In Asia, esophageal squamous cell carcinoma (ESCC) accounts for more than 90% of esophageal cancer cases and can be treated with minimally invasive esophagectomy (MIE); however, MIE has certain technical limitations in resecting lymph nodes. The advantages of robot-assisted minimally invasive esophagectomy (RAMIE) surgery, such as the high-definition three-dimensional (3D) vision and the presence of the EndoWrist, facilitates movement in challenging anatomical regions. However, few studies have compared the postoperative outcomes between RAMIE with MIE for the lymph node dissection of patients with ESCC. We identified 285 patients with ESCC who underwent surgical resection between January 2019 and April 2023. Of these patients, 270 met the screening criteria and were enrolled in our study. These patients were then divided into two groups according to the thoracic approach: MIE (n=168) or RAMIE cohort (n=102). The aim of this study was to investigate the possible advantages in terms of postoperative outcomes of RAMIE over MIE for thoracic lymph node dissection. Most patients were male (97.4%). According to the pathological-stage of esophageal cancer, 5 (1.9%), 99 (37.1%), 72 (27.0%), 82 (30.7%), and 9 (3.4%) patients were pathological-stage 0, I, II, III, and IV, respectively. The number of regional lymph node resections in the RAMIE cohort was significantly higher than that in the MIE group for the following regions: the left tracheobronchial lymph nodes (106tbL) (P<0.001), paratracheal lymph nodes [106pre] (P=0.011), the sub-longitudinal lymph nodes [107] (P<0.001), the left main bronchial lymph nodes [109L] (P<0.001), the right main bronchial lymph nodes [109R] (P<0.001), the sub-thoracic periesophageal lymph nodes [110] (P=0.004), and the supradiaphragmatic lymph nodes [111] (P<0.001). By comparing MIE cohort with RAMIE cohort, the transthoracic approach with RAMIE yielded a greater total number of thoracic lymph nodes dissected [MIE: mean 20.82, standard deviation (SD) 9.45; RAMIE: mean 26.07, SD 9.28; P<0.001] and a greater total number of lymph node groups that underwent thoracic lymph node dissection (MIE: mean 5.28, SD 1.94; RAMIE: mean 7.29, SD 1.77; P<0.001). Our study shows that RAMIE may be more effective than MIE in terms of the number thoracic lymph nodes dissected and the extent of dissection. Moreover, RAMIE may be not associated with additional surgical complications.

Surgical strategy for incidental intrahepatic cholangiocarcinoma in terms of lymph node dissection

BackgroundAlthough many guidelines recommend performing lymph node dissection (LND) during surgery for intrahepatic cholangiocarcinoma (ICC), there is no evidence for patients with incidentally detected ICC who did not undergo LND. This study aimed to identify the role of LND in patients with incidental ICC. MethodsThe data from 284 patients who had undergone radical surgery for ICC from 2000 to 2020 were retrospectively reviewed. The enrolled patients were divided into 3 groups according to their T stage (T1 vs T2 vs T3 + 4). Moreover, the patients of each T group were divided into 3 groups according to their nodal status (N0 vs N1 vs Nx) and their survival outcomes were compared. ResultsSurvival outcomes of Nx group were statistically similar to that of N0 group in T1 stage (Nx vs N0: disease-free survival [DFS] [months], 129.0 [75.6–182.4] vs 125.0 [65.7–184.3], P = .948; overall survival [OS] [months], 175.0 [153.9–196.1] vs 173.0 [109.0–237.0], P = .443). In contrast, survival outcomes of Nx group in the other T stage (T2 and T3 + 4) were poorer than that of N0 group and were better than that of N1 group. In addition, in the Nx subgroup analysis according to T stage, T1 group showed significantly better survival outcomes than the other groups (T1 vs T2 vs T3 + 4: DFS [months], 129.0 [75.9–182.1] vs 16.0 [9.8–22.2] vs 13.0 [0.3–25.7], P < .001; OS [months], 175.0 [153.9–196.1] vs 53.0 [30.8–75.2] vs 37.0 [17.6–56.4], P < .001). ConclusionPatients with ICC incidentally diagnosed as having T2 or above T stage may consider additional LND.

Oncological Safety of Skipping Axillary Lymph Node Dissection in Patients with Clinical N0, Sentinel Node-Positive Breast Cancer Undergoing Total Mastectomy

ObjectiveThis study aimed to determine whether sentinel lymph node biopsy (SLNB) alone could afford oncological outcomes comparable with axillary lymph node dissection (ALND) in patients with early breast cancer without palpable lymphadenopathy who underwent total mastectomy (TM) and were SLN-positive.MethodsThis study analyzed clinical data of 6747 patients with breast cancer who underwent TM between 2014 and 2018 in two tertiary hospitals in Korea. Overall, 643 clinical stage T1-3 N0 patients who did not receive neoadjuvant therapy and had one to two metastatic SLNs at the time of surgery were included. Propensity score matching was performed between the SLNB alone and ALND groups, adjusting for clinical T stage and number of metastatic SLNs. In total, 237 patients were allocated to each group.ResultsMean number of metastatic SLNs was 1.2 for the SLNB group and 1.6 for the ALND group. With a median follow-up of 65.0 months, 5 year disease-free survival was 90.8% for the SLNB group and 93.9% for the ALND group (hazard ratio [HR] 1.35, 95% confidence interval [CI] 0.70–2.58; p = 0.36). 5 year ipsilateral locoregional recurrence-free survival (LRRFS) was not significantly different between the two groups (95.1% and 98.3% for the SLNB and ALND groups, respectively) [HR 1.86, 95% CI 0.69–5.04; p = 0.21]. In the SLNB group, patients who received radiation therapy (RT) showed superior 5 year LRRFS than patients who did not receive RT (100% vs. 92.9%; p = 0.02).ConclusionCollectively, our findings suggest that SLNB could afford comparable outcomes to ALND in patients with early breast cancer and one to two metastatic SLNs who underwent TM. Importantly, RT could decrease locoregional recurrence in patients who underwent SLNB alone.

Minimally Invasive Treatment of Chyle Leak After Thyroidectomy and Cervical Lymph Node Dissection in Patients with Thyroid Carcinoma: Results of a Study Involving 36 Patients.

Chyle leak (CL) after head and neck surgery is a rare but well-known complication. In patients with high-output leakage, the treatment can be complicated. This study aims to report on a recent innovation in lymphatic intervention for treating such patients. A retrospective review of 36 patients with chyle leak after neck surgery for thyroid cancer was conducted to assess the efficacy of percutaneous lymphatic embolization and thoracic duct (TD) disruption. Antegrade catheterization of the thoracic duct was achieved in 31 of 36 patients (86.1%). Therefore, embolization of the thoracic duct and thoracic duct branches was performed in 26 and 5 patients, respectively. In 5 cases of unsuccessful antegrade catheterization into the thoracic duct, transcervical access embolization was performed in 2 patients, and TD disruption (TDD) was performed in 3 patients. The pooled overall technical success rate of lymphatic embolization was 33/36 patients (91.7%). One patient who underwent thoracic duct embolization (TDE) with technical success (1/33 patients) but clinical failure had additional treatment directly sclerosing the TD under computed tomography scan. Cervical fluid collection sclerotherapy was done in 7 patients as an additional treatment. Resolution of the chyle leak after procedures was observed in all patients (100%). The mean time to resolution was 3 days (1-7 days). There was no complication intra and after procedures. TDE, selective TD branches embolization and TDD are safe and effective minimally invasive treatments for CL post-surgery for thyroid carcinoma. Sclerosing cervical fluid collection contributes to clinical success.

SENTINEL LYMPH NODE BIOPSY IN TREATMENT OF PENILE CANCER

Objective: The management of lymph node metastases is crucial in penile cancer surgery. Sentinel lymph node biopsy (SLNB) is a minimally invasive procedure used to assess the presence of lymph node metastasis. The objective is to evaluate the efficiency of SLNB in the treatment of penile cancer. Methods: This retrospective observational study included 31 patients diagnosed with penile cancer who underwent surgery and SLNB at the National Hospital of Dermatology between January 2018 and May 2021. Results: The average age of patients was 58.4 ± 12.3 years old. The majority of patients had a history of phimosis (87.1%) and a treatment delay of over 1 year (67.7%). All 31 patients with penile cancer had squamous cell carcinoma (SCC) as the histological type, with the majority undergoing partial penectomy (87.1%). Out of 61 inguinal regions examined in 31 patients, lymph node metastasis was detected in one region (3.2%). The average follow-up time was 45.2 ± 12.1 months. One SLNB-negative patient was found to have inguinal lymph node metastasis after 12 months, resulting in a false-negative rate of 50%. The complication rate was 8.2%. Conclusion: SLNB utilizing a radioisotope tracer can significantly reduce the incidence and severity of complications associated with inguinal lymph node dissection in patients with penile cancer. Received 25 June 2023Revised 24 September 2023Accepted 28 November 2023

Laparoscopic D2+ lymph node dissection in patients with obesity and gastric cancer: A retrospective study.

D2 lymph node dissection is widely used in laparoscopic radical gastrectomy for gastric cancer, and its efficacy and safety are known for patients with obesity. Currently, D2+ lymph node dissection is also applied to certain patients with gastric cancer of later stages. Due to the high difficulty of D2+ surgery, it is more challenging to perform on patients with obesity. There is currently limited research on the efficacy and safety of D2+ surgery in obese patients with gastric cancer. The present study aimed to retrospectively analyze the clinical data of patients undergoing laparoscopic radical gastrectomy for gastric cancer admitted to a single gastroenterology department. Patients with a body mass index ≥25 kg/m2 were included in the study. A total of 149 patients were selected as the research subjects and divided into two groups. The observation group comprised 74 patients who underwent D2+ lymph node dissection, while the control group comprised 75 patients who underwent standard D2 lymph node dissection. The surgical performance, postoperative recovery and postoperative complications of the two groups were compared. The results showed that the rates of conversion to open surgery in the D2+ and D2 groups were 5.4% (4/74) and 2.7% (2/75), respectively, and were not significantly different. The duration of surgery in the D2+ group (282.55±23.02 min) was significantly longer than that in the D2 group (271.45±20.05 min). The mean number of lymph node dissections in the D2+ group was 28.57±7.19, which was significantly higher than that in the D2 group (25.29±6.41). No statistically significant differences in intraoperative blood loss, time to first flatus, postoperative hospitalization days, total hospitalization expenses or postoperative complications was detected between the two groups. There were no deaths in either group within the 30-day perioperative period. In addition, there was no significant difference in the 3-year overall survival rate between the two groups, while the 5-year overall survival rate of the D2+ group was significantly higher than that of the D2 group. For obese patients with gastric cancer, D2+ surgery may increase the duration of surgery and slightly increase intraoperative blood loss compared with standard D2 radical surgery, but does not increase the incidence of postoperative complications. Moreover, D2+ surgery increases the number of lymph node dissections and improves the 5-year survival rate of patients. Therefore, it may be concluded that laparoscopic D2+ lymph node dissection is safe and feasible for obese patients with gastric cancer.

Surgical Complications in Papillary Thyroid Cancer Patients with Cervical Lymph Node Metastases.

The reported complication rates of neck dissection are not specific patients with papillary thyroid cancer` with metastatic lymph nodes. This study aimed to describe the complication profile of neck dissection and the effect of concurrent lateral neck dissection on complication rates. This single-center prospective cohort study analyzed the data of 52 patients who underwent a total thyroidectomy and therapeutic lymph node dissection between March 2021 and March 2023. The clinicopathologic characteristics of patients and surgical complications were analyzed. The transient recurrent laryngeal nerve palsy (RLNP) and hypoparathyroidism rates were 55.8% and 51.9%, respectively. The chyle leakage rate was 5.8%. Tracheostomy was performed on 1 patient (1.9%). Patients with transient RLNP had more retrieved lymph nodes than patients without RLNP (5.5 ± 2.7 vs 3.9 ± 1.5, P = .013). The rates of transient RLNP and hypoparathyroidism were higher in the total thyroidectomy with central and lateral neck dissection group than the total thyroidectomy with central neck dissection group (62.2% vs 14.3%, P = .035 and 57.8% vs 14.3%, P = .046). Multivariate analysis showed that the increased number of retrieved lymph nodes in the central compartment and the addition of lateral neck dissection were independent risk factors for transient RLNP, with odds ratio (OR) (95% confidence interval) of 0.72 (0.53-0.98) and 9.42 (1.02-87.34). The rates of transient RLNP and hypoparathyroidism after lymph node dissection in patients with papillary thyroid cancer with metastatic lymph nodes were high, and a greater number of retrieved lymph nodes in the central neck and the addition of lateral neck dissection were predictors for transient RLNP. These data may be used to discuss preoperatively with patients and make surgeons more cautious and meticulous during surgery to minimize complications.

Problems of preoperative diagnosis of pelvic lymph node lesions in rectal cancer (review)

Background: metastasis in lateral pelvic lymph nodes (LPLN) occurred in 6–15% of patients with middle or low rectal cancer. Currently there are still no criteria of diagnosis of this. There is no generally accepted management this group of the patients.Aim: to systematize the available literature data about lateral pelvic lymph node dissection in patients with rectal cancer.Materials and Methods: literature search was performed in the PubMed and e-Library databases using the keywords: LLND, lateral lymph node, rectal cancer, lymphodissection. The search date: July 2023.Results: preoperative CRT with total mesorectumectomy supplemented with selective LTLD for suspected metastases seems to be a rational strategy to achieve a favorable oncological treatment outcome.Conclusion: Additional studies are required.

Optimal range of lymph node dissection in patients with unilateral papillary thyroid carcinoma with lateral cervical lymph node metastasis.

Whether patients with unilateral papillary thyroid carcinoma (PTC) with lateral cervical lymph node metastasis (LLNM) require prophylactic central regional lymph node dissection (CLND) remains unclear. Herein, we investigated the independent risk factors associated with contralateral central lymph node metastasis (cCLNM) in unilateral PTC with LLNM and analyzed the optimal extent of lymph node dissection by comparing the 5-year recurrence-free survival rates. We retrospectively analyzed 695 patients with unilateral papillary thyroid carcinoma and lateral cervical lymph node metastasis. Factors including sex, age, multifocal, location of primary tumor, tumor diameter, capsule invasion, thyroid nodular goiter, Hashimoto thyroiditis, ipsilateral central lymph node metastasis(iCLNM), and lateral cervical lymph node metastasis were analyzed using univariate and multivariate logistic regression analyses to explore the independent risk factors of cCLNM. Propensity scores were matched to compare the 5-year recurrence-free survival rates in patients divided by different lymph node metastases and dissections. Of all patients who underwent bilateral (b)CLND, 52% (149/286) had cCLNM. Receiver operating characteristic (ROC) curve analysis was performed on 286 patients who underwent bCLND, for which a tumor diameter of 20.5 mm and number of LLNM of 3.5 were used as the thresholds for predicting cCLNM. The 5-year recurrence-free survival (RFS) rates in the cCLN-negative and cCLN-positive groups were 98.6% and 91.2%, with statistically significant differences (P=0.034). The 5-year RFS rates showed no significant difference between the ipsilateral (i)CLND and bCLND groups (P=0.235). Multifactorial regression analysis showed that tumor diameter >2 cm, presence of iCLNM, and number of LLNM >3 were independent risk factors of cCLNM.But male sex, young age (<45 years), multifocality, location of primary tumor, capsule invasion, thyroid nodular goiter, and Hashimoto thyroiditis were not associated with cCLNM. Not all unilateral PTC with LLNM require prophylactic cCLND; however, prophylactic cCLND is necessary in cases which display high-risk factors for cCLNM, including primary diameter >2 cm, iCLNM, and number of LLNM >3.

Robot-Assisted versus Laparoscopic Surgery for Pelvic Lymph Node Dissection in Patients with Gynecologic Malignancies.

The objective of this study was to compare the surgical outcomes for pelvic lymph node dissection (PLND) performed through conventional laparoscopic surgery (CLS) versus robot-assisted surgery (RAS) in patients with gynecologic malignancies. Perioperative data, including operative time, estimated blood loss, and complications, were retrospectively analyzed in 731 patients with gynecologic malignancies who underwent transperitoneal PLND, including 460 and 271 in the CLS and RAS groups, respectively. Data were statistically analyzed using the Chi-square test or Student's t-test as appropriate. P < 0.05 was considered statistically significant. The mean age was 50 ± 14 years and 53 ± 13 years in the RAS and CLS groups (P < 0.01), respectively. The mean body mass index was 23.4 ± 4.8 kg/m2 and 22.4 ± 3.6 kg/m2 in the RAS group and CLS groups (P < 0.01), respectively. The operative time, blood loss, and number of resected lymph nodes were 52 ± 15 min, 110 ± 88 mL, and 45 ± 17, respectively, in the RAS group and 46 ± 15 min, 89 ± 78 mL, and 38 ± 16, respectively, in the CLS group (all P < 0.01). The rate of Clavien-Dindo Grade ≥ III complications was 6.3% and 8.7% in the RAS and CLS groups, respectively (P = 0.17). Shorter operative time and lower blood loss are achieved when PLND for gynecologic malignancies is performed through CLS rather than RAS. However, RAS results in the resection of a greater number of pelvic lymph nodes.

OGC P57 Are Cervical Lymph Node Dissections in Oesophageal Cancer Patients Undergoing Oesophagectomy Beneficial?

Abstract Background Cervical lymph node dissection in patients undergoing oesophagectomy can be indicated when there is suspicion of involved cervical nodes, although there is controversy around the benefits of this additional procedure on the prognosis of these patients. This study aims to assess the consequences and survival after cervical lymph node dissection, and to weigh the risks and benefits of this procedure. Methods This retrospective study included seven patients with oesophageal squamous cell carcinoma (SCC), and one with oesophageal adenocarcinoma who underwent cervical lymph node dissection in addition to oesophagectomy at the Churchill Hospital. There was a male to female ratio of 1:3, and all had neoadjuvant chemotherapy and were staged with PET-CT. PET staging scan results were compared pre and post neo-adjuvant therapy (NAT) to assess nodal involvement. Final histopathology was also recorded. Results All patients had evidence of cervical nodal involvement on PET scan, two of whom developed nodal involvement only after NAT. Only two patients had neck node involvement on histopathology: one had SCC and showed good response to NAT; the other had undifferentiated carcinoma and showed new para-tracheal node involvement after NAT, later developing supraclavicular node recurrence. Two cases were complicated by recurrent laryngeal nerve (RLN) injury, one with bilateral and one with partial vocal cord palsy. There was a 5-year survival rate of 62.5%, with non-survivors uniquely having recurrent disease. Conclusions Lymph node dissection alongside oesophagectomy achieved good 5-year survival in this small cohort, but with a significant risk of RLN injury. Further studies investigating the proportion of metastatic neck nodes found on dissection, long term survival benefits and cancer reoccurrence are required.

Evaluating the utility of robotic axillary lymph node dissection in patients with invasive breast cancer: a systematic review.

Robot-assisted axillary lymph node dissection (RALND) has been proposed to improve surgical and oncological outcomes for patients with breast cancer.To perform a systematic review of current literature evaluating RALND in patients with invasive breast cancer.A systematic search was performed in accordance with the PRISMA guidelines. Studies outlining outcomes following RALND were included.Two studies involving 92 patients were included in this review. Of these, 41 underwent RALND using the da Vinci© robotic system (44.57%), and 51 underwent conventional axillary lymph node dissection (CALND) (55.43%). There was no significant difference observed with respect to intra-operative blood loss or duration of procedure in those undergoing CALND and RALND (P > 0.050). One study reported a significant difference in lymphoedema rates in support of RALND (6.67% vs 26.67%, P = 0.038). Overall, data in relation to postoperative fat necrosis (10.00% vs 33.33%, P = 0.028), wound infection rates (3.33% vs. 20.00%, P = 0.044), and wound ≤ 40mm in length (63.63% vs. 19.05%, P = 0.020) supported RALND. Oncological outcomes were only reported in one of the studies, which concluded that there was no local or metastatic recurrence in either group at 3-month follow-up.These provisional results support RALND as a safe alternative to CALND. Notwithstanding, the paucity of data limits the robustness of conclusions which may be drawn surrounding the adoption of RALND as the standard of care. Further high-quality studies are required to ratify these findings.