Examination Of Nodes Research Articles

ASO Author Reflections: The Minimum Number of Examined Lymph Nodes in Thyroidectomy

ASO Author Reflections: The Minimum Number of Examined Lymph Nodes in Thyroidectomy

How Many Lymph Nodes are Enough in Thyroidectomy? A Cohort Study Based on Real-World Data.

Thyroidectomy with only limited examination of lymph nodes is considered to pose potential risk for harboring occult nodal disease in patients with papillary thyroid cancer (PTC). However, the optimal number of examined lymph nodes (ELNs) in patients with PTC with clinically lateral lymph node metastasis (cN1b) remains unclear. Patients with cN1b PTC who underwent therapeutic neck dissection were retrospectively enrolled. A β-binomial distribution was utilized to calculate the likelihood of occult nodal disease as a function of total number of ELNs, and recurrence-free survival analysis was performed using the Kaplan-Meier method. Together 982 patients met the inclusion criteria for this study, of which 853 patients had node-positive disease. The median ELN count was 23 (interquartile range 14-33). Increased ELN counts were associated with a decreased rate of occult nodal disease. The prevalence of nodal metastasis was 84%, while the corrected prevalence was 90%. The estimated probability of false-negative nodal disease was 67% for patients with PTC when only a single node was examined. Survival analysis revealed that populations with higher probability of occult nodal diseases experienced significantly higher recurrence rate. For patient with cN1b PTC, 20 ELNs were required to achieve 95% confidence of having no occult nodal disease. Minimum thresholds of 24, 14, 14, and 15 ELNs were selected for patients with pT1, pT2, pT3, and pT4 diseases, respectively. Our findings robustly conclude that a minimum of 20 ELNs is essential to assess the quality of neck dissection and acquire accurate staging for patients with cN1b PTC.

Ultrasound assessment of lymph nodes for staging of gynecological cancer: consensus opinion on terminology and examination technique.

The lymphatic pathway is an important route of metastasis in gynecological malignancy. Therefore, the examination of lymph nodes is an essential part of the ultrasound evaluation in patients with known or suspected gynecological malignancy. The lymph nodes most frequently involved in gynecological malignancy (apart from vulvar cancer) are parietal (retroperitoneal) and visceral abdominopelvic lymph nodes. In advanced disease, more distant lymph-node regions, such as the inguinal, axillary and supraclavicular lymph nodes, can also be involved. The standardized description of lymph nodes has been published previously by the Vulvar International Tumor Analysis (VITA) collaborative group. Herein, a collaborative group of gynecologists and gynecological oncologists with extensive ultrasound experience presents a systematic methodology for ultrasonographic lymph-node assessment performed as part of the locoregional and distant work-up to assess the extent of gynecological malignancy. The aim of this consensus opinion is also to describe the anatomical classification and drainage pathways of the lymphatic system as relevant to the gynecological organs. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Transformation sarcomateuse de la tumeur royale chez une patiente atteinte de la maladie de Recklinghaussen à Lomé (Togo)

Introduction: malignant tumors including soft tissue sarcomas can occur during neurofibromatosis type 1. We report a case of sarcomatous degeneration of a plexiform neurofibroma with multivisceral metastases in a Togolese patient with neurofibromatosis type 1. Observation: A 33-year-old female patient with neurofribromatosis type 1 presented with an altered general condition, pain and changes in the appearance of the plexiform tumour of her neurofibromatosis, which had been evolving for one month. Physical examination revealed multiple coffee-white spots (greater than 10), with tumours of soft consistency and variable size, scattered over the body. There was also a larger tumour (approx. 9cmx6 cm), located on the inside of the left ankle, fixed, firm and painful to palpation. The abdomen was enlarged and tender, with no tenderness or contracture. Examination of lymph nodes was normal. Anatomopathological examination of the biopsy-exeresis of this tumour revealed a proliferation of clusters of small, rounded, undifferentiated cells with reduced cytoplasm and hyperchromatic nuclei, with clear anisokaryosis and numerous atypical mitotic figures. There were also a few vascular emboli. We therefore concluded that this plexiform neurofibroma was malignant, and the extension work-up revealed pulmonary, pancreatic and adrenal metastases. The patient died 3 weeks after diagnosis in respiratory distress. Conclusion: Malignant degeneration of plexiform neurofibromas is possible in patients with neurofibromatosis type 1. It is therefore important to monitor these patients for early detection in order to limit the risk of metastasis and death.

Detached pyloric gland adenoma of gallbladder: A case report and review of literature.

Vigilant intraoperative inspection is crucial during gallbladder surgery to detect any abnormal tissue including the rare pyloric gland adenomas, which can be easily missed. Thorough examination and removal of unusual lymph nodes or thickened tissues are essential to prevent the risk of malignant transformation and ensure comprehensive patient care. Pyloric gland adenomas are uncommon tumors that can be discovered in various organs such as the stomach, gallbladder, and pancreas. Typically lacking noticeable symptoms, these tumors are categorized into subtypes, with the pyloric variant being the most frequent. The term "intracholecystic papillary-tubular neoplasms (ICPN)" is used to emphasize growth patterns and associated risks. In a discussed case, a detached pyloric gland adenoma was identified incidentally during a cholecystectomy procedure. A 58-year-old obese male presented with upper abdominal pain, nausea, and vomiting. He was diagnosed with early cholecystitis caused by gallstones. Subsequently, during a laparoscopic cholecystectomy, a detached adenoma was discovered. Vigilant screening is crucial, as the identification of gallbladder pyloric gland adenomas is a rare occurrence that might be missed during gallbladder surgery. Any unusual lymph nodes or thickened tissues found in association with the gallbladder ought to be carefully removed, as they could potentially indicate detached gallbladder adenomas with a significant risk of becoming malignant. Failing to consider this possibility may subject the patient to prolonged risks if not meticulously examined.

Survival Benefits of Postoperative Chemotherapy in Patients With Colorectal Mucinous Adenocarcinoma: An Analysis Utilizing Propensity Score Matching From the Surveillance, Epidemiology, and End Results Database.

This study aimed to investigate the characteristics of patients with colorectal mucinous adenocarcinoma (MAC) who benefit from postoperative chemotherapy (POCT) and to develop effective postoperative survival nomograms for predicting overall survival (OS) in colorectal MAC patients. Data of colorectal MAC patients who underwent surgery from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2020 were collected. Patients were grouped based on POCT, and intergroup analysis was performed using 1:1 propensity score matching (PSM). Kaplan-Meier (K-M) curves were used to compare the prognosis between the 2 groups. Cox analysis was employed to identify factors associated with OS in patients with colorectal MAC who underwent POCT. The variance inflation factor (VIF) and bilateral stepwise regression were used to determine factors included in the model. Additionally, a nomogram was constructed to predict postoperative survival outcomes for patients. The discriminative ability of the nomograms was evaluated using the C-index and calibration curve analysis, the decision curve analysis (DCA) assessed the clinical utility of the nomogram, and the receiver operating characteristic (ROC) curve evaluated the nomograms' performance. This study encompassed 6829 patients with colorectal MAC, among whom 2258 received POCT, and 4571 did not. Whether pre or post PSM, patients in the POCT group consistently exhibited a superior median OS compared to those in the postoperative non-chemotherapy group (P < .0001). For colorectal MAC patients undergoing POCT, OS was correlated with factors such as patient age, carcinoembryonic antigen levels, tumor deposits, perineural invasion (PNI), lymph node examination count, T staging, and Grade staging. Notably, a significant chemotherapy advantage was observed in patients without perineural invasion, those with lymph node examination counts exceeding 12, and patients with moderately differentiated tumors. The overall colorectal MAC patient postoperative OS predictive nomogram demonstrated a C-index of .74, with a calibration curve near the diagonal and a DCA curve indicating positive net benefits. In comparison to TNM staging, the ROC curves of the nomogram at 1 year, 3 years, and 5 years demonstrated superior predictive capabilities (AUC: .80 vs .71, .78 vs .71, .77 vs .70). This study revealed the characteristics of colorectal MAC patients who benefit from POCT and established effective prognostic nomograms, which can aid clinicians in designing personalized treatment plans for individual patients and promote precision medicine.

Evaluation of complications and biochemical recurrence rates after (super) extended lymph node dissection during radical prostatectomy

ObjectiveTo evaluate the effectiveness of extended (e-PLND) and super-extended pelvic lymph node dissection (se-PLND) during robot-assisted radical prostatectomy (RARP) by examining lymph node (LN) yield, complications, LN metastasis, and biochemical recurrence (BCR) incidence.MethodsBetween January 2016 and January 2020, 354 consecutive patients with > 5% risk of lymph node involvement (LNI), as predicted by the Memorial Sloan Kettering Cancer Center nomogram, underwent RARP with (s)e-PLND at a high-volume center. The e-PLND involved removing fibrofatty lymphatic tissue around the obturator fossa, internal iliac region, and external iliac vessels. The se-PLND, performed at the discretion of the surgeons, also included lymph nodes from the pre-sacral and common iliac regions. Outcomes included histopathological findings by anatomical region; complications; and BCR incidence during follow-up.ResultsThe median LNI risk was 18% (IQR 9–31%). A median of 22 LN (IQR 16–28) were removed, with se-PLND yielding a higher number: 25 (IQR 20–32) compared to e-PLND: 17 (IQR 13–24) (p < 0.001). pN1 disease was detected in 22% of patients overall, higher in se-PLND (29%) than e-PLND (14%) (p < 0.001). Of metastatic LNs, 14% were situated outside the e-PLND template. Operation time was longer for se-PLND, but perioperative complications were similar between both groups. After a median follow-up of 24 months (IQR 7–33), BCR incidence was comparable between the two groups.ConclusionCompared to standard extended pelvic lymph node dissection (PLND), super extended PLND increases lymph node yield and removal of metastatic deposits but does not contribute to progression free survival at mid-term.

LC-MS/MS analysis reveals plasma protein signatures associated with lymph node metastasis in colorectal cancer.

Colorectal cancer (CRC) is a major global health concern, ranking as the third most common cancer and the fourth leading cause of cancer-related deaths worldwide. Currently, the diagnostic accuracy of Lymph node metastasis (LNM) is currently unsatisfactory. Therefore, there is an urgent need to develop a reliable tool that can accurately predict lymph node metastasis (LNM) in patients diagnosed with CRC. We conducted an extensive proteomics investigation aimed at examining lymph node metastasis (LNM) in individuals diagnosed with colorectal cancer (CRC). In the discovery stage, employing a mass spectrometry-based proteomic approach, we analyzed a cohort of 60 colorectal cancer patients (NM=30, LNM=30), identifying distinct molecular profiles that differentiate patients with and without lymph node metastasis (LNM). Subsequently, we validated the protein classifier associated with lymph node metastasis. We elucidated a combinatorial predictive protein biomarker that can distinguish patients with and without lymph node metastasis by LC-MS/MS. The classifier achieved an area under the curve (AUC) of 0.892 (95% CI, 0.842-0.941), while in the testing cohort, it attained an AUC of 0.929 (95% CI, 0.824-1.000). Furthermore, the four protein markers demonstrated an AUC of 0.84 (95% CI, 0.783-0.890) in the validation cohort. Additionally, we categorized patients into three types based on immunophenotyping. Type 1 primarily consisted of patients with negative lymph node metastasis (NM), characterized by immune cells such as NK cells, CD4 T effector memory cells, and memory B cells. Type 2 mainly included patients with positive lymph node metastasis (LNM), characterized by immune cells such as mesangial cells, epithelial cells, and mononuclear cells. In Type 1, a prominent upregulation observed in immune inflammation, as well as in glucose and lipid metabolism. In Type 2, significant upregulation was evident in pathways such as pyrimidine metabolism and cell cycle regulation. The findings of this study suggest that immune mechanisms may exert a pivotal role in the process of lymph node metastasis in CRC. Here, we present plasma protein signatures associated with lymph node metastasis in colorectal cancer (CRC). However, further validation across multiple centers is necessary to generalize these findings.

A Predictive Model for Gastric Cancer-Specific Death after Gastrectomy: A Competing-Risk Nomogram.

We aimed to assess the likelihood of cause-specific death and other causes of death after gastrectomy for gastric cancer (GC). Additionally, a competing-risk nomogram was developed for patient counseling and decision-making. Eligible GC patients who had gastrectomy between 2007 and 2015 were included in the study from the Surveillance, Epidemiology, and End Results (SEER) database. Death from gastric cancer and death from other causes were considered as separate competing events. Cumulative incidence functions (CIF) were calculated for each event, and a competing-risk nomogram was developed. Overall, 8,808 patients who underwent gastrectomy were analyzed. Among them, 4,659 (52.90%) died from gastric cancer and 1,284 (14.58%) died from other causes. The five-year cumulative incidence of cause-specific death for gastric cancer was 50.4%, and 10.2% for deaths from other causes. Several independent factors, such as age at diagnosis, tumor site, grade, size, lymph node examination results, pathological T status, pathological N status, metastatic status, Lauren classification, radiation, and chemotherapy, were found to be associated with gastric cancer-specific death. The nomogram, based on results from the competing risk regression model, demonstrated good performance. We have developed a nomogram aimed at predicting gastric cancer-specific mortality in patients following gastrectomy. The model has undergone internal validation, demonstrating good accuracy and reliability. It serves as useful tool that can assist physicians and patients in making more informed clinical decisions.

Prognostic value of a modified pathological staging system for gastric cancer based on the number of retrieved lymph nodes and metastatic lymph node ratio.

The prognosis for gastric cancer (GC) remains grim, underscoring the importance of accurate staging and treatment. Given the potential benefits of using lymph node ratio (LNR) for improved prognostication and treatment planning, it is critical to incorporate examined lymph nodes (ELN) count in an integrated GC staging system. Patients data from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015 was utilized as training set. The Mantel-Cox survival test was used to calculate chi-square values for 40 LNR segments with a 0.025 interval, defining a novel LNR-based N (rN) classification based on the cutoff points. A revised AJCC (rAJCC) staging system was established by replacing the 8th AJCC N staging with a rN classification. The relationship between the ELN count and prognosis or positive lymph node detection was conducted by using multivariable models. The series of the odds ratios and hazard ratios were fitted with a locally weighted scatterplot smoothing (LOWESS) smoother, and the structural break points were determined by Chow test to clarify an optimal minimum ELN count. The integrated GC staging system incorporated both rAJCC system and the ideal ELN count. Discriminatory ability and prognostic homogeneity of the rAJCC and integrated staging system was compared with AJCC staging system in the SEER validation set (2016-2017), the Cancer Genome Atlas Program (TCGA) database, and the Third Affiliated Hospital of Sun Yat-sen University database. The current study found that LNR and ELN count are both significantly associated with the prognosis of GC patients (HR = 0.98, p < 0.001 and HR = 2.51, p < 0.001). Four peaks of the chi-square value were identified as LNR cut-off points at 0.025, 0.175, 0.45 and 0.6 to define a novel rN stage. In comparison to the 8th AJCC staging system, the rAJCC staging system demonstrated significant prognostic advantages and discriminatory ability in the training set (5-Y OS AUC: 71.7 vs. 73.0; AIC: 57,290.7 vs. 57,054.9). The superiority of the rAJCC staging system was confirmed in all validation sets. Using a LOWESS smoother and Chow test, a threshold ELN count of 30 was determined to maximum improvement in the prognosis of node-negative patients without downgrading due to potential metastasis, while also maximizing the detection efficiency of at least one involved lymph node. The integrated staging system, combining the refined rAJCC classification with an optimized ELN count threshold, has demonstrated superior discriminatory performance compared to the standalone rAJCC or the traditional AJCC system. The development of a novel GC staging system, which integrated the LNR-based N classification and the minimum ELN count, has exhibited superior prognostic accuracy, holding promise as a valuable asset in the clinical management of GC. However, it is crucial to recognize the limitations from the retrospective database, which should be addressed in subsequent analyses.

Enhancing Lymph Node Yield in Gastric Cancer Resection: Impact of Back Table Dissection on Number of Lymph Node Examined.

During gastric cancer resection, back table dissection (BTD) involves examination and separation of lymph node (LN) packets from the surgical specimen based on LN stations, which are sent to pathology as separately labeled specimens. With potential impact on clinical outcomes, we aimed to explore how BTD affects number of LNs examined. A retrospective review of a gastric cancer database was performed, including all cases of gastrectomy with D2 lymphadenectomy from January 2009 to March 2022. Back table dissection and conventional groups were compared using Mann-Whitney U and Fisher's exact tests. Multiple linear regression modeling was used to identify potential predictors of number of LN examined. A total of 174 patients were identified: 39 (22%) BTD and 135 (78%) conventional. More patients in the BTD group underwent neoadjuvant chemotherapy (62% vs 29%, P < .05). Compared to the conventional group, the BTD group had a greater number of LNs examined (42 [26-59] vs 21[15-33], median [IQR], P < .001), lower LN positivity ratio (.01 vs .07, P = .013), and greater number of LNs in patients with BMI >35 (32.5[27.5-39] vs 22[13-27], P = .041). A multiple linear regression model controlling for age, BMI, preoperative N stage, neoadjuvant chemotherapy, surgeon experience, and operative approach identified BTD as a significant positive predictor of number of LN examined (β = 19.7, P = .001). Back table dissection resulted in improved LN yield during gastric cancer resection. As a simple technical addition, BTD helps enhance pathology examination and improve surgeon awareness, which may ultimately translate to improve oncologic outcomes.

Evaluation of lymph node ratios and log odds of positive nodes as prognostic indicators in primary organ malignancy

BackgroundStaging of malignant tumours based on positive lymph node number and not taking into account the actual number of examined lymph nodes during surgery may lead to bias and fallacious results. The ratio of positive and resected lymph nodes (LNR) and log odds of positive nodes (LODDS) emerged as novel prognostic markers in deciding the future course of management better than the parameter pN in predicting cancer-specific survival. We aim to evaluate and compare the prognostic value of pN, LNR and LODDS in common primary organ malignancies like breast, head and neck, gastric and cervical cancers. MethodsThis was an ambidirectional observational study conducted from September 2018 to August 2021 with one year (from 2017 to 2018) for retrospective data collection archived from records. It included patients affected by breast, head and neck, gastric and cervical cancers and were followed up for a period of 3 years from the date of diagnosis to perform a holistic survival analysis. The sample was grouped by American Joint Committee on Cancer N stage, LNR and LODDS, and analysed using Kaplan–Meier and multivariate Cox proportional hazard models. ResultsThe study included 202 breast cancer patients, 85 head and neck cancer patients, 100 gastric cancer patients and 52 cervical cancer patients. Multivariate Cox regressions analysis demonstrated a lower Akaike Information Criterion (AIC) value for LODDS and LNR followed by pN stage. ConclusionThe novel indicators LNR and LODDS better predicted the biological behaviour irrespective of lymph node number and allowed clinicians to correctly stratify patients for better postoperative management.

Comparison of Long-Term Survival Between Robotic and Video-Assisted Lobectomy for Stage Ⅰ NSCLC With Radiologic Solid Tumors: A Propensity Score Matching Study

BackgroundTo compare the long-term survival between robotic and video-assisted thoracic surgery (VATS) lobectomy for stage Ⅰ non–small-cell lung cancer (NSCLC) with radiologic solid tumors. MethodsClinical stage Ⅰ NSCLC patients with radiologic solid tumors who underwent robotic-assisted thoracic surgery (RATS) or VATS lobectomy between 2015 and 2017 were retrospectively reviewed. A propensity score matching analysis was performed to balance the baseline characteristics. The primary end points were overall survival (OS) and recurrence-free survival (RFS). ResultsA total of 518 patients (225 RATS and 293 VATS) were included. After propensity score matching, there were 170 cases in each group. Patients undergoing RATS had shorter operative time than VATS (98.12 min vs. 112.26 min; p < 0.001). The RATS approach resulted in a higher number of resected lymph nodes (LNs) (11.75 vs. 9.77; p < 0.001). The postoperative complication rates were comparable (7.6% vs. 10.0%, P = .566). The rates of 5-year OS and RFS for the RATS and VATS were 92% versus 89% (P = .62) and 82% vs. 86% (P = .70), respectively. Multivariate analysis revealed that the number of resected LNs was significantly associated with overall survival (OR = 1.94 [95% confidence interval [CI]: 1.07-3.51], P = .029). ConclusionThe long-term survival outcomes of RATS and VATS are similar for c-stage Ⅰ NSCLC with radiologic solid tumors. The use of robotics is associated with more lymph node dissection and shorter operative time. We suggested that the number of examined lymph nodes rather than surgical approaches was associated with overall survival.

The Other Site of Rhabdomyosarcoma.

Rhabdomyosarcoma (RMS) is a rare malignant soft tissue sarcoma (STS), accounting for almost 50% of pediatric STSs. Due to its heterogeneity, RMS presents challenges in diagnosis and treatment, with prognosis varying depending on multiple factors. Tumors localized in the other site (OTH)-including the paraspinal, perianal, thoracic, abdominal, pelvic, and perineal regions-are generally classified as unfavorable. This study assesses the clinical features and prognoses of RMS in OTH locations depending on its site of origin. An explorative analysis of RMS cases from the SEER 17 database 2000-2020 was conducted. Patients of all ages with histologically confirmed RMS as primary malignant disease classified under OTH, were included. OTH was categorized in four granular site classifications. Overall survival (OS) and disease-specific survival (DSS) were analyzed using Kaplan-Meier estimators. Factors independently influencing survival, including a site classification model presented in this study, were identified through Cox regression analysis. Out of 4168 patients with RMS, 990 cases of RMS with the OTH site met the inclusion criteria. The median age was 16 years. The predominant histological subtypes were embryonal (33.0%) and alveolar (25.5%). Most tumors were ≥ 5 cm (median 9 cm) and located primarily in the pelvic region (41.5%). The 3-, 5-, and 10-year OS rates were 45.4% ± 3.332 (95% CI), 40.7 ± 3.332, and 38.6% ± 3.332, respectively, while DSS rates were 43.3% ± 3.136 (95% CI), 38.3% ± 3.136, and 35.1% ± 3.332. In the multivariate analysis age, histological type, site in a granular categorization, stage, regional lymph node examination, and regional lymph node involvement (pathologically proven) were independently associated with survival. Through both univariate and multivariate analyses, an OTH favorable group could be established. The OTH favorable group consists of the anal region, gallbladder and biliary tract, and breast. RMS in OTH shows significant differences in prognosis, putting the current categorization as unfavorable into question and making a more detailed classification necessary. Furthermore, pathological regional lymph node assessment is specifically in the OTH localization recommended.

Medical education during the COVID-19 pandemic: An online-only course can achieve good to medium psychomotor skill level of basic head and neck examination

Background/ObjectivesNew teaching methods are warranted to meet the demand for increased flexibility in medical education while making optimal use of the limited resources of educators. The COVID-19 pandemic forced universities to resort to online-only teaching, even for training of psychomotor skills. The objectives of this study were: (I) to investigate the performance of students without previous experience in ear, nose and throat (ENT) examination after completing an asynchronous online teaching course in an objective standardized clinical examination (OSCE) and (II) to evaluate the degree of over- and underestimation of their abilities. MethodsThe study was designed as a prospective, single-institution medical education cohort study. Medical students (n = 54; 3rd/4th year, no previous head and neck examination skills) completed a comprehensive online training for basic head and neck examination skills 1–14 days before undergoing an OSCE on 5 different examination items (cervical lymph node examination, oral/oropharyngeal examination, otoscopy, Weber/Rinne hearing test, anterior rhinoscopy). Expert-evaluated theoretical knowledge and practical abilities were measured using Likert scales (1 = high proficiency to 5 = low proficiency). Participants self-evaluated their own skills before and after the OSCE (5-point Likert scales). ResultsStudents achieved an overall good to medium skill level in basic head and neck examination after online training. Increased psychomotor complexity of tasks contributed to worse performance. Expert evaluation of practical skills was better in male participants and those who rated their preparation as thorough. Low/no misjudgment (discrepancy between self- and expert-evaluation) was observed in most participants, while high discrepancy levels (strong misjudgment) were mainly attributable to the students’ underestimation of their own abilities. ConclusionsOnline training of head and neck examination skills is a cost- and resource-efficient introduction to skill training and was inevitable during the pandemic. However, it cannot replace practical hands-on training, especially in tasks with high psychomotor requirements. Refresher-courses could compensate for cancelled skill training during the pandemic.

The role of wedge resection and lymph node examination in stage IA lung carcinoid tumors.

Current guidelines recommend anatomical resection and mediastinal lymph node resection for stage I to IIIA pulmonary carcinoids (PCs). The role of wedge resection in stage IA PCs remains controversial, previous studies focused on typical carcinoids (TCs) while differentiating histological subtypes preoperatively is not easy. We aimed to study the effect of wedge resection and lymph node examination (LNE) in patients with stage IA PCs. Patients who underwent anatomical and wedge resection for stage T1N0M0 lung carcinoid tumors between 2004 and 2019 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were also divided into a non-LNE group and an LNE group. Kaplan-Meier analysis and the log-rank test were used to calculate and compare overall survival (OS). Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to balance the variables between groups. Univariate and multivariate Cox proportional hazard models were developed to determine prognostic factors. A total of 2,029 patients with bronchopulmonary carcinoid tumors were included in this study, 1,450 underwent lobectomy, 147 underwent segmentectomy and 432 underwent wedge resection. Initially, 5-year survival differed marginally between wedge and anatomical resection (91% vs. 95%, P=0.051), but lost significance after adjustment. LNE improved 5-year survival (95% vs. 89%, P=0.003), and this remained significant after adjustment. In multivariate cox analysis, LNE remained a significant variable while extent of resection was not. This result also remained consistent after adjustment. OS was comparable between wedge resection and anatomical resection when at least 1 lymph node was examined. For early-stage PC, wedge resection was not inferior to anatomical resection in terms of OS, while LNE significantly increased the survival in both multivariate and matched studies. The relationship between surgical extent and survival in the unadjusted study may be attributed to the lower rate of LNE in wedge resection. Our findings support wedge resection with emphasis on LNE in early-stage PCs.

Enlightenment of robotic gastrectomy from 527 patients with gastric cancer in the minimally invasive era: 5 years of optimizing surgical performance in a high-volume center - a retrospective cohort study.

Learning curves have been used in the field of robotic gastrectomy (RG). However, it should be noted that the previous study did not comprehensively investigate all changes related to the learning curve. This study aims to establish a learning curve for radical RG and evaluate its effect on the short-term outcomes of patients with gastric cancer. The clinicopathological data of 527 patients who underwent RG between August 2016 and June 2021 were retrospectively analyzed. Learning curves related to the operation time and postoperative hospital stay were determined separately using cumulative sum (CUSUM) analysis. Then, the impact of the learning curve on surgical efficacy was analyzed. Combining the CUSUM curve break points and technical optimization time points, the entire cohort was divided into three phases (patients 1-100, 101-250, and 251-527). The postoperative complication rate and postoperative recovery time tended to decrease significantly with phase advancement ( P <0.05). More extraperigastric examined lymph nodes (LN) were retrieved in phase III than in phase I (I vs. III, 15.12±6.90 vs. 17.40±7.05, P =0.005). The rate of LN noncompliance decreased with phase advancement. Textbook outcome (TO) analysis showed that the learning phase was an independent factor in TO attainment ( P <0.05). With learning phase advancement, the short-term outcomes were significantly improved. It is possible that our optimization of surgical procedures could have contributed to this improvement. The findings of this study facilitate the safe dissemination of RG in the minimally invasive era.

Prognostic significance of an innovative staging system based on the logarithmic odds of positive lymph nodes for resectable gastroesophageal cancer after neoadjuvant chemoradiation: a population-based study with external validation of data

BackgroundAfter receiving neoadjuvant chemoradiation, the number of examined lymph nodes in resectable gastroesophageal cancer (GEC) will decrease, this may not accurately determine the N staging. So our study evaluates the clinical significance of a new staging model based on the logarithmic odds of positive lymph nodes (LODDS) in patients with GEC after receiving neoadjuvant chemoradiation.MethodsA total of 1 130 patients with pathologically diagnosed GEC who received neoadjuvant chemoradiation from 2004 to 2019 included in the National Cancer Institute Surveillance, Epidemiology, and Results (SEER) database were selected for analysis. Lymph nodes were staged according to the AJCC TNM staging system (eighth edition) and LODDS. Patient prognosis across the two systems were evaluated by the Kaplan–Meier method, differences in node staging were evaluated by the Akaike information criterion and Bayesian information criterion. In addition, 914 patients from our center were externally validated.ResultsCompared to the traditional TNM staging system, the new TLODDSM staging system was comprised of stage I, stage II, stage IIIA, stage IIIB, and stage IVA, and decision curve analysis showed that the new staging system had higher benefits for different decision thresholds than the old staging system. The Akaike information criterion and Bayesian information criterion of the new staging system was lower than those of the old staging system, indicating the sensitivity of the TLODDSM staging system for predicting the prognosis of patients was higher. In addition, stage-IIIB or -IVA patients in the new staging system benefited from adjuvant chemotherapy. The externally validated data from our center supported this conclusion.ConclusionsCompared to the TNM staging system, the TLODDSM staging system has significant advantages in predicting prognosis of patients with GEC who have completed neoadjuvant chemoradiation, guiding the adjuvant chemotherapy for patients.

Does neoadjuvant therapy contribute to increased risk in anastomotic leakage of esophageal cancer? A network meta-analysis.

Conflicting results have been reported about the impact of neoadjuvant therapy on anastomotic leakage (AL) after esophagectomy. We aimed to unravel the potential effect of neoadjuvant therapy on AL after esophagectomy through a network meta-analysis. A Bayesian network meta-analysis was performed by retrieving relevant literature from PubMed, EMbase, The Cochrane Library and Web of Science Core Collection. Randomized clinical trials (RCTs) and retrospective studies (RS) comparing the following treatment modalities were included: neoadjuvant chemoradiation (nCRT), neoadjuvant chemotherapy (nCT), neoadjuvant radiotherapy (nR), neoadjuvant immunochemotherapy (nICT), and surgery alone (SA). Subgroup analyses by radiation dose, examined lymph nodes (ELN), route of reconstruction, site of anastomosis, and surgical approach were also conducted. A total of 62 studies with 12,746 patients were included for the present study, among which 17 were RCTs. There were no significantly statistical differences observed among the five treatment modalities in AL for both RCTs (nCRT-nICT: risk ratio 1.51, 95% confidence interval 0.52-4.4; nCT-nICT: 1.71, 0.56-5.08; nICT-nR: 0.79, 0.12-8.02; nICT-SA: 0.59, 0.2-1.84) and RS (nCRT-nICT: odds ratio 1.53, 95% confidence interval 0.84-2.84; nCT-nICT: 1.56, 0.87-2.88; nICT-SA: 0.6, 0.31-1.12; nICT-nR: 1.08, 0.09-36.02). Subgroup analysis revealed that no significant difference in AL was observed among the five treatment modalities except for the impact of nCRT versus nCT (0.21, 0.05-0.73) on AL with a radiation dose ≥41.4Gy. Neoadjuvant therapy do not significantly increase the incidence of AL after esophagectomy. Administration of irradiation with a moderate dose is not associated with elevated risk in AL. Clinicians can be less apprehensive about prescribing nCRT.

Autopsy findings from patients diagnosed with COVID-19 demonstrate unique morphological patterns in bone marrow and lymph node

AimsThe identification of haemophagocytosis in bone marrow (BM) is recurrently identified in patients with severe COVID-19. These initial COVID-19 autopsy studies have afforded valuable insight into the pathophysiology of this...