Lymph Node Dissection For Stage Research Articles

Capromab Pendetide imaging of prostate cancer.

Capromab Pendetide imaging illustrates the successful translation of monoclonal antibody technology from the laboratory to the clinic. It provides a means of identifying otherwise occult soft tissue metastases in patients with adenocarcinoma of the prostate. When utilized with other clinical, pathological and laboratory findings, Capromab Pendetide imaging enables more accurate disease staging and monitoring than is afforded by other imaging modalities such as CT and MRI. In the primary disease setting Capromab Pendetide imaging should be reserved for use in patients with negative bone scans who are at high risk for metastatic disease based on such factors as advanced clinical stage, high Gleason score and significantly elevated serum PSA or alkaline phosphatase. Due to low sensitivity for small-volume disease, a negative Mab scan may not eliminate the need for a staging lymph node dissection but should encourage further consideration of local treatment options. Capromab Pendetide should be used with caution in patients at low risk for metastatic disease. Positive scan findings in low risk patients should be confirmed before altering the treatment plan since some false positive scans should be anticipated in a population with low disease prevalence. Capromab Pendetide imaging has not been shown to be reliable in determining the local extent of the primary tumor but new techniques involving co-registration of SPECT and CT images show promise in this regard. In the patient with recurrent disease following primary therapy, the predictive value of Capromab Pendetide imaging of the prostate or prostate fossa is limited, particularly following RT. Its more important role in this setting is to identify lymph node metastases in the high risk patient with a negative bone scan who might otherwise be a candidate for local salvage therapy. A large prospective study is needed for confirmation, but preliminary data suggest that Capromab Pendetide imaging is helpful in identifying those patients with PSA elevation after radical prostatectomy who are most likely to benefit from salvage RT. As with any imaging technique, Capromab Pendetide has strengths and weaknesses that must be understood to maximize patient benefit by utilizing the scan in clinical settings where it is most likely to be useful and least likely to be misleading. Capromab Pendetide is a technically demanding procedure best performed and interpreted at sites with experience and expertise.

Combined inguinal and pelvic lymph node dissection for stage III melanoma.

The incidence of melanoma is increasing in the UK and a significant number of patients are still presenting with primary lesions of poor prognosis. As a consequence there is likely to be an increasing number of patients with lymph node metastases for whom the appropriate extent of groin dissection remains controversial. This review summarizes the evidence to enable surgeons to make an informed decision about the management of patients with melanoma metastases to the groin lymph nodes. A Medline search was performed to identify all English language articles about melanoma containing the words lymphadenectomy, lymph nodes, inguinal or lymphoedema. Eighty-seven relevant articles were selected from 3904 abstracts retrieved; 34 were related directly to the aim of this review. There are no randomized controlled trials comparing the outcome of combined inguinal and pelvic lymph node dissection (CLND) and superficial inguinal lymph node dissection (SLND). Excision of pelvic lymph node metastases is reported to yield a 5-year survival rate of 0-35 per cent. Recurrence within the pelvis occurs in 9-18 per cent of patients after SLND and in less than 5 per cent after CLND. Morbidity following either CLND or SLND is poorly reported. Major long-term lymphoedema limiting patient activity affects 6-20 per cent of patients after groin dissection. Cloquet's node was demonstrated in one study to be a useful predictor of pelvic lymph node involvement. Patients may be selected for pelvic node dissection on the basis of clinical findings, the results of pelvic computed tomography and the status of Cloquet's node. The controversy surrounding the appropriate management of cytologically positive inguinal nodes in melanoma can be resolved only by a prospective randomized trial comparing CLND with SLND. Morbidity and local disease control must be measured as outcomes in addition to disease-free and overall survival.

Transvaginal Evisceration of Small Bowel after Radical Hysterectomy and Pelvic Lymphadenectomy

Vaginal evisceration is a rare event. This case report describes a 45-year-old woman who presented 8 days following radical hysterectomy and lymph node dissection for stage 1B squamous cell carcinoma of the cervix with small bowel evisceration through the vagina. She was treated by laparotomy and resection anastamosis of a discolored part of the distal ileum.

A Case of Complete Remission after Chemotherapy and Retroperitoneal Lymph Node Dissection in Stage B2Nonseminoma

A Case of Complete Remission after Chemotherapy and Retroperitoneal Lymph Node Dissection in Stage B₂Nonseminoma

Prostate Specific Antigen Based Disease Control Following Ultrasound Guided sup 125 Iodine Implantation for Stage T1/T2 Prostatic Carcinoma

Purpose We report the prostate specific antigen (PSA) based recurrence-free survival rate after 125iodine (sup 125 I) implantation for early stage prostatic carcinoma. Materials and Methods A total of 197 patients with clinical stage T1 or T2 prostatic carcinoma underwent outpatient 125I seed implantation. Followup was 1 to 7 years (median 3). Pretreatment serum PSA levels were elevated (greater than 4.0 ng./ml.) in 138 patients (70 percent). There were 105 well differentiated (Gleason score 2 to 4), 87 moderately differentiated (Gleason score 5 to 6) and 5 indeterminate tumors. The prescribed minimum prostatic dose was 160 Gy. The total dosage of 125I implanted ranged from 15 to 62 mCi. (median 37). Staging lymph node dissection and seminal vesicle biopsies were not routinely performed. Results Among 138 patients with an elevated PSA level before implantation and no prior hormonal treatment, the PSA value returned to normal in 98 percent and decreased to less than 1.0 ng./ml. in 82 percent within 24 months of treatment. In 97 percent of those 138 patients the PSA level decreased to less than 1.0 ng./ml. at 48 months after implantation. Of 8 patients with an increasing PSA value 5 also had clinically evident failure. The actuarial rate of chemical (increasing PSA) or clinical failure at 5 years following implantation was 7 percent, with 15 patients still at risk at 5 years. There was a trend for higher failure rates among patients with higher pretreatment PSA levels (p = 0.57), Gleason scores 5 and 6 versus 2 to 4 (p = 0.51) or higher stage of disease (p = 0.17). Conclusions There is a high rate of clinical and chemical freedom from progression following 125I implantation for select patients with early stage prostatic carcinoma.

Role of elective lymph node dissection in stage I malignant melanoma: evaluation by matched pair analysis.

The role of elective lymph node dissection (ELND) in clinical stage I malignant melanoma continues to be controversial. We present a matched pair analysis of 375 patients treated in the Department of Dermatology in Kassel between 1979 and 1991 by wide local excision (WLE) plus ELND. Multivariate analysis revealed tumor thickness, level of invasion, age, sex, and localization as independent prognostic factors, and 375 patients treated by WLE alone were matched as controls to the patients treated by ELND and WLE. There was no significant benefit from WLE plus ELND compared to WLE alone in the total group as shown by the 5-year survival rates (87.3% versus 86.4%) and 10-year survival rates (80.1% versus 77.82%). Increased survival rates were noted for tumor thicknesses 1.51-4.0 mm for the WLE plus ELND group, as shown by the 10-year survival rates of 73.1% versus 60.3%. However, these data were not significant (p = 0.14). Disease-free survival rates were significantly higher in the group treated by additional ELND for all tumor thicknesses (p < 0.05) and even more in intermediate tumor thicknesses of 1.51-4.0 mm (p < 0.001). A significant benefit of elective lymph node dissection was detected for malignant melanoma of the trunk (all tumor thicknesses), as shown by the 5-year survival rates of 92.0% versus 79.7% and 10-year survival rates of 80.4% versus 45.16% (p < 0.05). Malignant melanoma of the extremities revealed no significant differences in survival rates. We conclude that there is a certain benefit from ELND in clinical stage I malignant melanoma for tumor thicknesses of 1.51-4.00 mm. Especially in malignant melanoma of the trunk, WLE plus ELND was more beneficious than WLE alone.

The role of elective lymph node dissection in stage I malignant melanoma

The role of elective lymph node dissection in stage I malignant melanoma

Complications of pelvic Lymph Node Dissection: Laparoscopy vs Open Surgery

Intraoperative and postoperative complications were assessed in 44 patients undergoing pelvic lymph node dissection for staging of prostatic cancer. In 24 cases an open surgical lymphadenectomy was performed and in the other 20 cases the lymphadenectomy was by laparoscopic approach. Complications in the surgical group were 3 (12%), more or less the same as those of the laparoscopic group (2 cases, 10%). In our opinion with experience of laparoscopic surgical principles, the risk of complications may be minimized so that laparoscopic pelvic lymphadenectomy offers a reliable and minimally invasive alternative to open dissection in selected patients.

Elective lymph node dissection in stage I malignant melanoma: a meta-analysis.

The role of elective lymph node dissection (ELND) in stage I melanoma has been a controversial issue for decades. Numerous studies have been conducted to try to establish the benefit of ELND versus wide local excision (WLE). The majority of these studies suggest no significant difference in survival, although some investigations have shown ELND to be of benefit in intermediate thickness (0.76-3.99 mm) melanomas. In order to resolve this ongoing controversy, a meta-analysis was undertaken to review and analyse the results of previous reports. There was a total of 10,132 patients of whom 3,409 in 15 studies underwent ELND for all melanoma patients and 3,618 patients of whom 1,336 in eight studies had ELND for intermediate thickness (0.76-3.99) melanomas. No significant 5-year survival was present in all patients treated with ELND (p > 0.05, confidence intervals -0.0780, 0.0788), however, a significant 5-year survival was found in the intermediate thickness subgroup (p < 0.0001, confidence intervals -0.02, 0.22). Therefore, ELND may be valuable for improving the prognosis of patients with intermediate thickness melanomas.

Results of surgery for stage III A lung cancer

Forty-seven patients with stage III A lung cancer underwent pulmonary resection at Shinshu University Hospital. The overall 5-year survival rate was 27% (T1N2 T2N2 T3N2 ; 22%, T3N0 T3N1 ; 53%). In 22 patients with squamous cell carcinoma the 5-year survival rate was 48%, and in 22 with adenocarcinoma and it was 17%. Mediastinal lymph node metastasis was a poor prognostic factor in patients with lung cancer. No patients with subcarinal lymph node metastasis survived 4 years. It is valuable to perform mediastinal lymph node dissection for stage III A lung cancer.

Role of temporary iridium-192 interstitial implant in the treatment of carcinoma of the prostate

Two hundred patients with biopsy proven adenocarcinoma of prostate with Stages A to C were treated between July 1977 and December 1985. All patients underwent bilateral retroperitonea 1 pelvic lymph node dissection for staging and transperineal afterloading Iridium-192 implant to prostate; delivering minimum tumor dose of 30 to 40 Gy over 40-60 hours. In addition, all patients with Stage B and C disease also received external megavoltage radiation to prostate to doses of 30 to 40 Gy over 34 to 44 weeks. Local tumor control was defined by digital examination only when there was complete resolution of previously palpable nodules, masses or induration. This was achieved in 191/200 (95.5%) patients with minimum followup of 4 years (median 6.8 years). 74 patients had been rebiopsied at an average time interval of 2 years after completion of treatment. Only 12 (16%) patients had positive biopsies. The overall 5 year actuarial survival of entire group is 95%. Disease free survival has been correlated with stage and histology. Treatment related moderate to severe complications such as cystitis, proctitis, rectal ulcerations or fistulae occurred in 14% of patients initially (in first 100 cases). This has been critically analyzed in detail and several modifications and corrections have been introduced in the original treatment protocol resulting in complication rate of less than 4% without significant change in overall local tumor control.

Reliability of frozen section examination in identifying poor prognostic indicators in Stage I endometrial adenocarcinoma

Management of Stage I adenocarcinoma of the uterus includes hysterectomy, bilateral salpingo-oophorectomy, and selective paraaortic and pelvic lymphadenectomy. Postoperative radiation therapy (RT) is selectively employed in patients with histologically defined poor prognostic indicators. We attempted to identify these poor prognostic indicators by frozen section (FS) at primary surgery in 55 patients with Stage I endometrial adenocarcinoma; we found an excellent correlation between the results obtained on gross examination of the uterus with selected FS and the results after extensive sampling and microscopic examination of permanent section (PS). The depth of myometrial invasion was accurately predicted in 96.5%, and histologic grade in 94.5% of these patients. Sixty-six percent of patients with occult invasion of the cervix on PS were identified on FS. Using the above criteria, we identified by FS all patients ( 15 55 ) who required adjuvant RT obviating the need for pelvic lymph node dissection. On the basis of our prliminary data, we recommend the use of careful gross examination and selective FS to identify patients requiring selective pelvic and paraaortic lymphadenectomy and adjuvant therapy, thereby eliminating the need for staging lymph node dissection with its associated morbidity and complications.

Localization of Solitary and Multiple Metastases in Stage II Nonseminomatous Testis Tumor as Basis for a Modified Staging Lymph Node Dissection in Stage I

Because of a continuing need for pathological staging of clinical stage I testicular tumors an investigation was performed to determine the primary sites of metastatic involvement of the retroperitoneal lymph nodes and to define narrowly limited ipsilateral areas of lymph node dissection strictly for the purpose of staging. Surgical/pathological localization of solitary metastases provides the most direct evidence of primary lymphatic spread. There were 214 consecutive patients with stage II disease (excluding bulky disease) evaluated with respect to localization relative to the side of the involved testis and the number of metastases up to 5cm. Solitary metastases of 5cm. or less were found in 74 patients, 53 patients had 5 or less lymph nodes of 2cm. or less and 87 patients had more than 5 lymph nodes of between 2 and 5cm. Solitary nodes of the right testis tumor were located with decreasing frequency in the upper and lower interaortocaval, lower paracaval and precaval, upper precaval and right common iliac, upper paracaval and upper preaortic zones. Primary deposits of the left testis tumor were seen predominantly in the upper para-aortic zone. Upper preaortic and lower para-aortic zones were involved infrequently, and other areas were affected only in rare cases. These data contradict the assumption of a testicular lymph center located at the openings of the testicular veins into the vena cava and left renal vein, respectively. Multiple metastases were spread over the entire retroperitoneum, except for the external iliac regions. Hilar/suprahilar metastases were seen infrequently. Ipsilateral areas are defined according to primary involvement. A modified retroperitoneal lymph node dissection within ipsilateral areas is proposed as a staging operation for clinical stage I disease and a radical retroperitoneal lymph node dissection is indicated for pathological stage II disease.

Sexual function after bilateral retroperitoneal lymph node dissection for nonseminomatous testicular cancer.

This study concerns the sexual functions of 101 patients who had undergone bilateral retroperitoneal lymph node dissection for stage I or II nonseminomatous testicular cancer between 1969 and 1982. All patients were without evidence of disease after at least 4 years of follow-up. Antegrade ejaculation was present in 12 patients, while 89 patients experienced "dry ejaculation." Urine collected after intercourse or masturbation from 75 patients with dry ejaculation showed retrograde ejaculation in 55 and lack of ejaculatory emission into the urethra in 20 patients. Regarding other sexual functions, 17 patients had a diminished sexual desire (especially those patients who had received radiotherapy), 12 experienced difficulty reaching organism, and 6 complained of erectile dysfunction. The incidence of a contralateral hydrocele developing after retroperitoneal lymph node dissection seems to correlate with ligation of the contralateral spermatic vessels and their lymphatics. A review of the literature is presented comparing the types of dissection with the incidence of sexual disorders after retroperitoneal lymph node dissection. Since preserving normal ejaculation and fertility is important, a modified or unilateral retroperitoneal lymph node dissection, when required, is advocated. In patients, with stage I disease the therapy may be limited to an orchiectomy without lymph node dissection. In patients with retroperitoneal lymph node metastases combination chemotherapy with cisplatin and tumor excision gives good results. Patients with true retrograde ejaculation can be treated with alpha-sympathomimetic drugs such as imipramine HCl, and thus be offered the chance of fatherhood by coitus.

Anatomical and functional changes in the lower urinary tract after radical hysterectomy with lymph node dissection as studied by dynamic urethrocystography and simultaneous urethrocystometry

Seventeen urologically healthy women undergoing standardized radical hysterectomy with lymph node dissection for stage I carcinoma of the cervix were evaluated urodynamically before, immediately after, and 1 year after surgery, by dynamic videourethrocystography and simultaneous urethrocystometry. The surgical technique had been developed in order to preserve as much of the nerve and blood supply to the bladder and urethra as possible. Major dysfunction was found in the early postoperative state, but the lower urinary tract almost always regained its preoperative functional status in the course of approximately 1 year. There were no long-lasting functional changes which interfered with daily life, although small static and dynamic changes were observed. The changes occurred chiefly above the urogenital diaphragm. The results of the two urodynamic examinations, each giving different information, corresponded well. Used together they gave a more complete picture than used separately. Dynamic videourethrocystography offered information about the function of the bladder and urethra which could not be obtained by urethrocystometry alone.

Delayed regional lymph node dissection in stage I melanoma of the skin of the lower extremities.

Delayed regional lymph node dissection in stage I melanoma of the skin of the lower extremities.