Examination Of Nodes Research Articles

Fluorescence lymphoscopy with sentinel lymph node biopsy in research of lymphatic flow in early gastric cancer

To analyze the incidence and risk factors of regional lymph node metastatic lesions, as well as patterns of lymphatic drainage in early gastric cancer using indocyanine green (ICG). A prospective single-center non-randomized study included 67 patients with early gastric cancer between 2016 and 2019. All patients underwent endoscopic dissection or surgical resection with sentinel lymph node biopsy. Regional lymph node metastatic lesions were detected in 12 (20.2%) out of 59 patients with examined lymph nodes. Of these, 11 out of 12 patients had sentinel lymph node lesion, and only 1 patient had metastasis outside this lymph node. The proposed technique for sentinel lymph node biopsy demonstrated high sensitivity, specificity and accuracy (93.2%, 100% and 98.3%, respectively). Risk factors for metastasis of early gastric cancer to regional lymph nodes were high grade adenocarcinoma (p=0.038) and tumor of anterior gastric wall (p=0.013). All patients with tumors of the upper third of the stomach had sentinel lymph node in the left gastric artery basin. Lymph flow was multidirectional in patients with tumors of the middle third of the stomach. In tumors of the lower third of the stomach, sentinel lymph node was located in the right gastroepiploic artery (50%) and left gastric artery basins (36.84%) (p=0.002). Sentinel lymph node was located in the left gastric artery basin in 84% of patients with tumors of the lesser curvature (p<0.001). Lymphatic drainage was multidirectional if tumors were localized on anterior and posterior walls, as well as on the greater curvature. The proposed technique for sentinel lymph node biopsy demonstrated high sensitivity, specificity and accuracy (93.2%, 100% and 98.3%, respectively). ICG is valuable to identify the first lymph node in lymphatic drainage pathway in 83.6% of cases that makes it possible to assess the regional lymphatic collector. In addition, sentinel lymph node biopsy with ICG contributes to analysis of lymphatic drainage in early gastric cancer. The last one has both scientific and practical significance.

Evaluation of lymph node findings in patients with and without odontogenic infection: A clinical and ultrasonographic study.

The present study aimed to evaluate the ultrasonographic findings of submandibular and submental lymph nodes in patients with and without odontogenic infection. Systemically healthy patients aged 18-30 years old with or without odontogenic infections were included in this study. Clinical examinations were performed on all patients; those with any odontogenic infection were placed in the study group, and those without were placed in the control group. Ultrasonographic examinations of bilateral submental and submandibular lymph nodes were performed for both groups. The data were statistically analyzed using Pearson's Chi-square test and Student's t-test. A total of 150 patients voluntarily participated (female: n=86 (57%), male: n=64 (43%)), 75 in the study group and 75 in the control group. During the ultrasonographic examination, patients in the study group had more than one lymph node the same patient was mostly detected, in the study group (right submandibular: n=42, 56%, and left submandibular: n=43, 57.3%). The long-axis diameter of the submandibular lymph nodes was 9.305.30 mm and 5.505.20 mm in the study and control groups, respectively. Ultrasonography revealed that the presence, number, and long-axis diameter of the submandibular lymph nodes in the patients with and without odontogenic infection were statistically different.

Possibilities of bioregulation therapy in the treatment of patients with chronic tonsillitis

Background. There are numerous diagnostic methods and therapy regimens for chronic tonsillitis (CT). Different methods of treatment in certain conditions do not always show high efficiency, so the search for new ways of conservative management of CT is needed, the main task of which is palatine tonsils preservation.Objective: to evaluate the efficacy and tolerability of a multicomponent preparation with low dosage of active substances Lymphomyosot® in adult patients with CT and cervical lymphadenopathy in real clinical practice.Material and methods. A total of 170 male and female patients aged 18–65 years with CT (simple form and 1st degree toxic-allergic form) and cervical lymphadenopathy were included in an observational, open, prospective study. In the main group (n=85), a combined therapy consisting of standard CT therapy (a course of palatine tonsils lavage with 0.9% NaCl solution) with the addition of Lymphomyosot® was administered. In the control group (n=85), topical non-steroidal anti-inflammatory drugs or phytotherapy were used instead of the studied drug. Ultrasound examination of regional cervical lymph nodes with measuring of their diameter (longitudinal, transverse) was chosen as a parameter of objective assessment of patients' condition dynamics. The results of therapy at Visit 1 and Visit 2 (12±2 days after Visit 1) were compared. The effectiveness of treatment regimens was analyzed according to the following parameters: complaints related to CT; oropharyngoscopic data; evaluation of CT indicators by the doctor and the patients; dynamics of cervical regional lymph nodes size; satisfaction of the doctor and the patients with the clinical effect and tolerability of therapy.Results. The dynamic observation showed a significant decrease in the number of complaints and symptoms according to objective examination, oropharyngoscopy, as well as evaluation of symptoms by the doctor and the patients at Visit 2 in both groups (p&lt;0.001). However, in the main group, where Lymphomyosot® was administered in the complex treatment, there was a more significant decrease in cervical lymph nodes size compared to the control group (p&lt;0.01).Conclusion. The study demonstrated that Lymphomyosot® increased the efficacy of complex therapy, reducing cervical lymphoadenopathy and other manifestations of the disease in patients with CT (simple and 1st degree toxic-allergic forms).

Sufficient Regional Lymph Node Examination for Staging Adenocarcinoma of the Appendix.

The presence of lymph node (LN) metastasis is a known negative prognostic factor in appendix cancer (AC) patients. However, currently the minimum number of LNs required to adequately determine LN negativity is extrapolated from colorectal studies and data specific to AC is lacking. We aimed to define the lowest number of LNs required to adequately stage AC and assess its impact on oncologic outcomes. Patients with stage II-III AC from the National Cancer Database (NCDB 2004-2019) undergoing surgical resection with complete information about LN examination were included. Multivariable logistic regression assessed the odds of LN positive (LNP) disease for different numbers of LNs examined. Multivariable Cox regressions were performed by LN status subgroups, adjusted by prognostic factors, including grade, histologic subtype, surgical approach, and documented adjuvant systemic chemotherapy. Overall, 3,602 patients were included, from which 1,026 (28.5%) were LNP. Harvesting ten LNs was the minimum number required without decreased odds of LNP compared with the reference category (≥20 LNs). Total LNs examined were <10 in 466 (12.9%) patients. Median follow-up from diagnosis was 75.4 months. Failing to evaluate at least ten LNs was an independent negative prognostic factor for overall survival (adjusted hazard ratio 1.39, p < 0.01). In appendix adenocarcinoma, examining a minimum of ten LNs was necessary to minimize the risk of missing LNP disease and was associated with improved overall survival rates. To mitigate the risk of misclassification, an adequate number of regional LNs must be assessed to determine LN status.

Ultrasound Assessment of the Condition of Peripheral Lymph Nodes (Literature Review). Ultrasound Classification Node-RADS (US)

The article is the consensus opinion of specialists involved in ultrasound examination, computed and magnetic resonance imaging of peripheral, abdominal and retroperitoneal lymph nodes, oncologists, authors of clinical recommendations of the Russian Society of Head and Neck Tumor Specialists based on an analysis of modern literary sources devoted to the problem of assessing the condition lymph nodes. The purpose of the publication is to bring ultrasound terms to uniform standards when describing lymph nodes, to introduce the Node-RADS system into the practice of ultrasound examination, to improve mutual understanding between diagnosticians and clinicians in the interpretation of ultrasound results in assessing the condition of lymph nodes, optimize the work of primary care ultrasound diagnostic doctors.

Comparison of microvascular flow imaging and contrast-enhanced ultrasound for blood flow analysis of cervical lymph node lesions.

To compare the diagnostic value of microvascular flow imaging (MVFI) with that of contrast-enhanced ultrasound (CEUS) for the analysis of blood flow in benign and malignant cervical lymph nodes. As a prospective study, 95 cervical enlarged lymph nodes (43 benign and 52 malignant) were observed in 95 patients using conventional ultrasonography (including gray and Color Doppler Flow Imaging), CEUS, and MVFI. Two researchers evaluated vascular parameters of MVFI (vascular distribution, internal vascular features, vascular index) and CEUS (enhancement mode, enhancement type) and compared the diagnostic effects of MVFI and CEUS.All results were compared with pathological findings. There were significant differences in the vascular distribution and internal vascular features of benign and malignant lymph nodes on MVFI (P < 0.05). The vascular distribution of benign lymph nodes was mainly of the central and avascular types, the internal blood vessels were mostly normal, the vascular distribution of malignant lymph nodes was mainly mixed, the internal vessels were mainly tortuous and displaced. The optimal cut-off value of the benign and malignant lymph node vascular index (VI) was 15.55%, and the area under the receiver operating characteristic curve (AUC) of the VI was 0.876. There were also significant differences in the enhancement mode and types of benign and malignant lymph nodes in CEUS (P < 0.05). The benign lymph nodes showed centrifugal perfusion, and the enhancement types were mostly type I and type II. Most malignant lymph nodes showed centripetal or mixed perfusion, and the enhancement types were usually type III and type IV. The accuracy, sensitivity, and specificity of CEUS in the diagnosis of lymph node lesions were 84.2%, 84.6% and 83.7%, respectively, and the AUC was 0.845. The accuracy, sensitivity, and specificity of MVFI in the diagnosis of lymph node lesions were 85.3%, 84.6%, and 86.0%, respectively, and the AUC was 0.886. Both CEUS and MVFI are valuable in differentiating benign and malignant lesions of lymph nodes and have a similar diagnostic performance; however, MVFI is less invasive and simpler than CEUS. Therefore it is preferred for auxiliary examination of enlarged lymph nodes that are difficult to diagnose by conventional ultrasound.

Postoperative results, learning curve, and outcomes of pancreatectomy with arterial resection: a single-center retrospective cohort study on 236 procedures

Background: Newer chemotherapy regimens are reviving the role of pancreatectomy with arterial resection (PAR) in locally advanced pancreatic cancer. However, concerns about the early outcomes and learning curve of PAR remain. This study aimed to define the postoperative results and learning curve of PAR and provide preliminary data on oncologic outcomes. Materials and methods: A single center’s experiences (1993–2023) were retrospectively analyzed to define the postoperative outcomes and learning curve of PAR. Oncologic results were also reported. Results: During the study period 236 patients underwent PAR. Eighty PAR (33.9%) were performed until 2012, and 156 were performed thereafter (66.1%). Pancreatic cancer was diagnosed histologically in 183 patients (77.5%). Induction therapy was delivered to 18 of these patients (31.0%) in the early experience and to 101 patients (80.8%) in the last decade (P&lt;0.0001). The superior mesenteric artery (PAR-SMA), celiac trunk/hepatic artery (PAR-CT/HA), superior mesenteric/portal vein, and inferior vena cava were resected in 95 (40.7%), 138 (59.2%), 189 (80.1%), and 9 (3.8%) patients, respectively. Total gastrectomy was performed in 35 (18.5%) patients. The thirty-day mortality rate was 7.2% and ninety-day mortality rate was 9.7%. The learning curve for mortality was 106 PAR (16.0% vs. 4.6%; odds ratio, OR=0.25 [0.10–0.67], P=0.0055). Comparison between the PAR-SMA and PAR-CT/HA groups showed no differences in severe postoperative complications (25.3% vs. 20.6%), 90-day mortality (12.6% vs. 7.8%), and median overall survival. Vascular invasion was confirmed in 123 patients (67.2%). The median number (interquartile range) of examined lymph nodes was 60.5 (41.3–83) and rate of R0 resection was 66.1% (121/183). Median overall survival for PAR was 20.9 (12.5–42.8) months, for PAR-SMA was 20.2 (14.4–44) months, and for PAR-CT/HA was 20.2 (11.4–42.7). Long-term prognosis improved by study decade (1993–2002: 12.0 [5.4–25.9] months, 2003–2012: 15.1 [9.8–23.4] months, and 2013–present: 26.2 [14.3-51.5] months; P&lt;0.0001). Conclusions: In recent times, PAR is associated with improved outcomes despite a steep learning curve. Pancreatic surgeons should be prepared to face the technical challenge posed by PAR.

Longitudinal Analysis of Local Recurrence and Survival After Transanal Abdominal Transanal Radical Proctosigmoidectomy for Low Rectal Cancer Treated With Neoadjuvant Chemoradiation Therapy.

The transanal abdominal transanal radical proctosigmoidectomy was developed in 1984 as a sphincter preservation surgery in patients with low rectal cancers after preoperative radiation therapy. While serving as a catalyst for disruptive sphincter preservation surgery, it continues to be used and evolve. With the controversy over safety and local recurrence in other sphincter-preserving surgery, review of transanal abdominal transanal radical proctosigmoidectomy long-term oncologic outcomes is warranted. To assess local recurrence and survival after transanal abdominal transanal radical proctosigmoidectomy after neoadjuvant chemoradiation therapy. Retrospective cohort study of a prospectively maintained database. Tertiary rectal cancer referral center. Patients with low adenocarcinoma (≤5 cm anorectal ring) receiving neoadjuvant chemoradiation therapy and then transanal abdominal transanal radical proctosigmoidectomy for curative resection between 1998 and 2021. Local recurrence rates and overall survival rates. Of 255 included patients, 67.8% were men (n = 173); the mean age was 58.7 years (SD 11.5) and the mean BMI was 27.1 (SD 5.4), with 50.2% (n = 128) having ASA class II and 49.8% (n = 127) having ASA class III/IV. The mean tumor size was 4.8 cm (SD 1.9), the majority of patients had clinical T3 disease (81.8%; n = 184), and 52.1% had nodal disease (n = 100). The median radiation dose was 5400 cGy, with 73.7% (n = 149) achieving good response and 90.2% (n = 230) receiving minimally invasive surgery. The complete total mesorectal excision rate was 94.3%, and 100% of patients (n = 255) had negative distal margins. The mean number of examined lymph nodes were 13.9 (SD 10.7). After a median follow-up of 55.4 months, 5.1% of patients (n = 13) developed local recurrence at a median time of 29.6 months. The 5-year overall survival was 84.1% (95% CI, 78.8-89.4). Retrospective review with risk of bias and lack of generalizability. In this longitudinal study, the transanal abdominal transanal radical proctosigmoidectomy demonstrated excellent long-term locoregional control and survival in very low rectal cancers. The superior transanal abdominal transanal radical proctosigmoidectomy outcomes are durable over time, warranting expansion of the sphincter-preserving surgery technique. See Video Abstract . ANTECEDENTES:La proctosigmoidectomía radical transanal abdominal se desarrolló en 1984 como una cirugía de preservación del esfínter en cánceres de recto bajo después de la radiación preoperatoria. Si bien sirve como catalizador para la cirugía disruptiva de preservación del esfínter, continúa utilizándose y evolucionando. Con la controversia sobre la seguridad y la recurrencia local en otras cirugías que preservan el esfínter, se justifica la revisión de los resultados oncológicos a largo plazo de la proctosigmoidectomía radical transanal abdominal.OBJETIVO:Evaluar localmente después de Proctosigmoidectomía Radical Transanal Abdominal Transanal después de quimiorradiación neoadyuvante.DISEÑO:Estudio de cohorte retrospectivo de una base de datos mantenida de forma prospectiva.AJUSTES:Centro terciario de referencia para el cáncer de recto.PACIENTES:Adenocarcinoma bajo (=/<anillo anorrectal [ARR] de 5 cm) que recibió quimiorradiación neoadyuvante y luego proctosigmoidectomía radical transanal abdominal transanal para resección curativa entre 1998-2021.PRINCIPALES MEDIDAS DE RESULTADO:Tasas de recurrencia local y tasas de supervivencia general.RESULTADOS:De los 255 incluidos, el 67,8% eran varones (n = 173), con una edad media de 58,7 años (desviación estándar 11,5), con un índice de masa corporal medio de 27,1 kg/m2 (desviación estándar, 5,4) y el 50,2% (n = 128) estadounidenses. Sociedad de Anestesiología II. El tamaño medio del tumor fue de 4,8 cm (desviación estándar 1,9), la mayoría clínica T3 (81,8%, n = 184) y el 52,1% tenía enfermedad ganglionar (n = 100). La dosis de radiación mediana fue de 5400cGy, y el 73,7% (n = 149) logró una buena respuesta. El 90,2% (n = 230) se sometió a cirugía mínimamente invasiva. La tasa de escisión mesorrectal total completa fue del 94,3% (n = 83/87) y el 100% (n = 255) tuvo márgenes distales negativos. La media de ganglios linfáticos examinados fue de 13,9 (desviación estándar, 10,7). Después de una mediana de seguimiento de 55,4 meses, el 5,1% (n = 13) de los pacientes desarrollaron recurrencia local, en una mediana de tiempo de 29,6 meses. La supervivencia global a 5 años fue del 84,1% (IC 95%: 78,8-89,4).LIMITACIONES:Revisión retrospectiva con riesgo de sesgo y falta de generalización.CONCLUSIONES:En este estudio longitudinal, la proctosigmoidectomía radical transanal abdominal demostró un excelente control locorregional a largo plazo y supervivencia en cánceres de recto muy bajos. Los resultados superiores de la proctosigmoidectomía radical transanal abdominal son duraderos en el tiempo, lo que justifica la expansión de la técnica quirúrgica de preservación del esfínter. (Traducción-Dr. Osvaldo Gauto ).

Convenient method to improve efficiency of lymph node examination after gastrectomy with D2 lymphadenectomy for gastric cancer

BackgroundThe D2 procedure has been accepted as the standard treatment for advanced gastric cancer (GC) in East Asia. Determination of the number of lymph nodes (LNs) after gastrectomy may influence the pathological stage assessment of lymph node metastasis, significantly influencing prognostic evaluations and formulation of chemotherapy regimens.MethodsBetween January 2020 and January 2022, the medical files of 312 patients with clinical stage T0-4aN0-3M0 gastric cancer were reviewed retrospectively, and the patients were assigned to the normal group (lymph nodes were examined roughly), manual group (lymph nodes were manually examined meticulously), and device group (lymph nodes were examined by device). The clinical and pathologic characteristics, number of lymph nodes harvested, and the time required for lymph node examination was compared.ResultsA total of 312 gastric cancer patients (mean age 65.8 ± 10.3 years, 85 females and 227 males) underwent gastrectomy with curative intent at our department. Sex, age, body mass index (BMI), tumor size, clinical TNM stage, and pathologic TNM stage in the three groups showed no statistically significant differences (P > 0.05). The mean number of harvested lymph nodes in the normal, manual, and device group was 24.2, 36.6 and 35.2, respectively, which showed significant differences (P < 0.0001). The mean number of positive lymph nodes in the normal, manual, and device group was 3.5, 3.9 and 3.9, respectively (P = 0.99). The mean time consumption in device group was 15 min while the time consumption in manual group was 52.3 min, which showed a significant difference (P < 0.0001).ConclusionThis improved lymph node examination method offers a simple approach that is worth promoting, and it can improve the number of harvested lymph nodes efficiently.

Effect of examining lymph nodes count on mortality risk in resected T1 non-small-cell lung cancer.

This study aims to estimate the effect of the examined lymph node count (ELNC) on the cancer-related mortality risk and non-cancer-related mortality risk in patients with resected T1 non-small-cell lung cancer (NSCLC). Patients diagnosed as primary T1 NSCLC between 2000 and 2017 were extracted from the Surveillance, Epidemiology and End Results database. Patients were divided into 2 groups according to the ELNC cutoff value, which was calculated based on overall survival outcomes. Propensity score matching was used to equalize the differences in baseline characteristics between groups. A total of 38242 resected T1 NSCLC patients were extracted from the database with the ELNC cutoff value of 8. After propensity score matching, 27676 patients were included in this study. Examining ≥8 ELNC was associated with a more accurate assessment of lymph node (LN) metastasis and significantly improving the prognosis. These trends remained consistent in subgroup analysis by histology type. In competing risk mode, examining ≥8 LNs could significantly reduce the risk of death from lung cancer, risk of death from chronic obstructive pulmonary disease, and risk of death from cardiac diseases. In the subgroup analysis, these trends were consistent. Given the mortality risk associated with lung cancer, chronic obstructive pulmonary disease, and cardiac diseases, at least 8 LNs should be examined in surgery for T1 NSCLC.

Invasive Solid Papillary Carcinoma of breast in an elderly male: a rare entity in an uncommon gender - case report and review of literature

Abstract Introduction/Objective Male breast cancers (MBC) account for less than 1% of all breast cancers. Papillary cancers constitute less than 3% of MBCs. Solid papillary carcinoma (SPC) is a rare subtype of papillary cancer with a solid growth pattern associated with fibrovascular cores. SPC is an indolent disease that typically presents in a post- menopausal woman as a central breast mass. Neuroendocrine differentiation, ER/PR positive status and Her-2 neu negative status are characteristic. SPC can be in situ or have invasive components. SPC is a rare entity in men and so far, approximately less than 40 cases of SPC in men have been discussed in literature. Here, we report a rare case of SPC with multiple invasive foci in an elderly male. Methods/Case Report An 84-year-old white male presented with a painless mass in his left breast. Excision biopsy revealed Solid Papillary Carcinoma. He subsequently underwent a Left Modified Radical Mastectomy with Left Sentinel Lymph Node Excision. The final histopathology report showed a background of SPC with multiple invasive foci with largest focus measuring 2 mm. Margins were negative and lymph nodes were negative for malignancy. The tumor was ER and PR positive, Her-2 neu negative and had a Ki-67 proliferation index of 42%. Negative IHC staining for Cytokeratin AE1/AE3 confirmed the absence of metastatic epithelial cells in the examined lymph nodes. Results (if a Case Study enter NA) N/A Conclusion SPC is an uncommon subtype among the papillary lesions of breast. Furthermore, only a few cases of SPC have been reported in men. Despite its rarity, it has a good prognosis and lymph node positivity, distant metastasis and local recurrence are uncommon. However, there is limited data about SPC with invasive components which may behave like other invasive breast lesions leaving management a dilemma for clinicians. We believe this case will add to the scarce existing literature about invasive SPC in men.

Comparison of survival between diffuse type and intestinal type early-onset gastric cancer patients: A large population-based study.

Currently, little knowledge about the survival of early-onset gastric cancer and little evidence about the difference of survival based on Lauren type has been reported. In order to investigate the difference, we conducted a retrospective study using the Surveillance, Epidemiology, and End Results (SEER) database and compared it comprehensively. SEER database was used to extracted patients and multiple imputation was utilized to fill blank data. Multivariate cox regression analysis and competing risk model were used to identify the risk factors of survival. K-M survival curve and propensity score matching (PSM) was applied to compare the difference of survival of patients based on Lauren type. Totally, we extracted 3932 EOGC patients including 2086 diffused type and 1846 intestinal type. K-M survival curve showed patients aged 20 to 29 had worse survival compared to patients aged at 30 to 45 years. The survival of EOGC patients would be greatly improved after surgery. Multivariate cox regression analysis revealed diffused type was an independent risk factor, as well as T stage, lymph node metastasis, tumor size (>5 cm) and metastasis, while surgery treatment and examined lymph nodes were protective factors. Multivariate competing risk regression model also showed diffused type was risk factor. We performed PSM by matching 1433 diffused EOGC with 1433 intestinal EOGC patients, finding patients with diffused type had a poorer survival. our results revealed that compared to diffused type EOGC, intestinal type was characterized by a better survival. EOGC should be attached more attention by clinicians.

ASO Author Reflections: Effect of the Number of Examined Lymph Nodes on Survival in Gastric Signet-Ring Cell Cancer.

ASO Author Reflections: Effect of the Number of Examined Lymph Nodes on Survival in Gastric Signet-Ring Cell Cancer.

Impact of Removal of Lymph Nodes on Survival in Stage I-III Gastric Signet-Ring Cell Cancer: The More, the Better?

There is an ongoing debate over the prognostic value of the number of examined lymph nodes (ELNs) in cases of gastric signet-ring cell cancer (GSRCC). In this study, we sought to evaluate the correlation between the number of ELNs and the prognosis of GSRCC and identify the optimal number of ELNs. A total of 1020 patients diagnosed with GSRCC between 2011 and 2018 in the National Cancer Center database were identified. Clinicopathological characteristics were retrospectively collected, and optimal cutoff values of ELNs were calculated by using X-tile. The impact of different ELNs on overall survival (OS) was compared by using Kaplan-Meier curves. We used univariate and multivariate Cox and subgroup analyses to explore the relationship between ELNs and OS. Furthermore, nonlinear correlations were investigated by using restricted cubic splines (RCSs). X-tile showed that the optimal cutoff value of ELNs was 22. The 5-year OS was higher for patients with ELNs > 22 (vs. ELNs ≤ 22, 66.9% vs. 74.9%, P = 0.026). Multivariate Cox analyses showed that high ELNs were associated with superior OS (hazard ratio = 0.56, 95% confidence interval 0.43-0.74, P < 0.001). In subgroup analyses, the significant association between tumor size > 4cm, and TNM III stage was still observed. The RCS regression model showed a U-shaped dose-response nonlinear relationship between ELNs and OS; the inflection point, as well as the lowest risk points, corresponded to 44-52 ELNs. A U-shaped, nonlinear correlation with inflection points of 44-52 ELNs between ELNs and prognosis in GSRCC was identified.

Laser Therapy in Comprehensive Treatment of Patients with Lymphedema of Lower Limbs

INTRODUCTION: Methods of physiotherapy using intravenous laser irradiation of blood (ILIB) that affects various pathogenetic factors of lymphedema, permits to achieve the required therapeutic effect and shows its promising perspectives.&#x0D; AIM: Evaluation of the effectiveness of ILIB to reduce the lymphedema volume in the lower limbs.&#x0D; MATERIALS AND METHODS: In 2020–2022, a comprehensive conservative treatment including compression therapy, pharmacotherapy and ILIB, was conducted in 60 patients of the mean age 45.3 ± 1.6 years with I–III stage lymphedema. Group 1 included patients with primary (n = 8) and group 2 (n = 52) with secondary lymphedema of the lower limbs. Laser radiation at 632 nm wavelength was used with standardized parameters: power 3 to 15 mW, pulse rate 80 to 2,000 Hz, exposure time 5 to 15 min, with a course (up to 10 sessions), daily, or interval (every 2nd day) load. Lymph outflow, microcirculation, soft tissues of the affected limb were evaluated using electrocoagulography, ultrasound examination of inguinal lymph nodes and soft tissues, triplex scanning, thermal imaging and McClure-Aldrich test.&#x0D; RESULTS: At the end of the treatment course, a reduction of the limb perimeter at the level of the middle third of the lower leg by 14.8 ± 0.7% was noted (from 48.7 ± 5.3 cm to 41.4 ± 0.9 cm). After 4 sessions and a treatment course, electrocoagulography revealed hypocoagulation with the formation of a loose clot with early retraction. Spearman test showed a direct relationship between changes in the fibrinolytic activity of blood and the perimeter of the lower leg in patients of group 2 with I–II stage of the disease (p 0.005). Thermography of the lower limbs showed increased IR radiation with a statistically significant increase (p 0.001) in the area of hyperthermia in the distal parts of the lower legs and the inner surface of the thighs. The results of McClure-Aldrich test showed a statistically significant slowdown of a skin papule resolution in the distal part of the lower legs from 27.13 ± 2.77 min to 35.72 ± 3.11 min (р 0.05) after ILIB in I stage of the disease.&#x0D; CONCLUSION: ILIB affects the internal factors of lymph outflow and contributes to its optimization in the comprehensive treatment of patients in the initial stage of secondary lymphedema of the lower limbs.

Patient management after primary rectal cancer diagnosis. Special focus on surgical treatment for non-metastatic disease

Background: Rectal cancer is a public health priority. Primary objectives of this study were to evaluate the quality of care for non-metastatic rectal cancer using process and outcome indicators. Delay of management, length of stay and readmission rate, sphincter preservation, morbidity, number of examined lymph nodes, mortality, overall and disease-free survivals were evaluated. Secondary objectives were to estimate the relationship between possible predictive parameters for (1) anastomotic leakage (logistic regression), (2) overall or disease-free survivals (cox regression). Methods: We performed a retrospective study on 312 consecutive patients diagnosed with primary rectal cancer between 2016 and 2019. We focused on the 163 patients treated by surgery for non-metastatic cancer. Results: The treatment began within 33 days (range 0–264) after incidence, resection rate was 67%. Digestive continuity rate in lower, middle and upper rectum was 30%, 87% and 96%. Median of 14 lymph nodes (range 1–46) was analyzed. Length of stay and readmission rate were 11 days (range 3-56) and 4%, respectively. Within 90 postoperative days, clinical anastomotic leakage occurred in 9.2% of cases, major morbidity rate was 17%, mortality 1.2%. Multivariate analysis revealed that stoma decreased the risk of anastomotic leakage [hazard ratio: 0.16; 95% confidence intervals: 0.04–0.63; p = 0.008]. The 5-year overall survival after surgery was 85 ± 4%, disease-free survival 83 ± 4%. Patients with major complications, male gender and R1/R2 resection margin had a poorer prognosis. Conclusion: This work showed encouraging results in rectal cancer treatment in our institution, our results were in line with recommendations at the time.

Reasons for Requesting Ultrasonography: A Retrospective Study.

The aim of this study is to evaluate (i) the reasons for requesting ultrasonography (USG) in a dentistry faculty and (ii) the scanning regions, the type of probe used, and the use of Doppler USG. USG request forms of patients who applied to our radiology clinic for USG were analyzed retrospectively. According to the clinical information of the patients in the request forms, the reasons for requesting USG were divided into four groups: soft tissue swelling, soft tissue calcification, lymph node, and other examinations. Data were statistically compared between sex (female and male) and age groups (≤40-years-old and ˃40-years-old). The USG request forms of 50 patients were obtained. The mean patient age was 45.06±14.50 years. Twenty-six patients were female (52%), while twenty-four patients were male (48%). Soft tissue swelling, soft tissue calcification, lymph node, and other examinations were noted as the reasons for requesting USG in 42%, 26%, 18%, and 14% of the patients, respectively. The most scanned regions were the submandibular (56%), parotid (16%), and cheek (10%) regions. Extraoral probe was used more frequently than intraoral probe (78% vs. 22%). Doppler USG was used in most patients (98%). A statistically significant difference was found between age groups and calcification examination (p<0.05). The reasons for requesting USG were mostly soft tissue swelling, soft tissue calcification, and lymph node examinations. The most commonly scanned region and used type of probe were the submandibular region and extraoral probe, respectively. Doppler USG was used in most patients.

Prognostic factors in patients with high-risk stage II colon cancer after curative resection: a post hoc analysis of the JFMC46-1201 trial

PurposeThe goal of the current study was to identify prognostic factors for disease-free survival (DFS) and overall survival (OS) in high-risk stage II colon cancer.MethodsThe subjects were patients with histologically confirmed stage II colon cancer undergoing R0 resection who met at least one of the following criteria: T4, perforation/penetration, poorly differentiated adenocarcinoma, mucinous carcinoma, and < 12 examined lymph nodes. Patients self-selected surgery alone or a 6-month oral uracil and tegafur plus leucovorin (UFT/LV) regimen. Serum CEA mRNA at ≥ 24 h after surgery and < 2 weeks after registration was also examined as a potential prognostic factor for stage II colon cancer. This study is registered with UMIN-CTR (protocol ID: UMIN000007783).Results1880 were included in the analysis to identify prognostic factors for DFS and OS in patients with high-risk stage II colon cancer. In multivariate analyses, gender, depth of tumor invasion, extent of lymph node dissection, number of examined lymph nodes, and postoperative adjuvant chemotherapy (POAC) emerged as significant independent prognostic factors for DFS. Similarly, multivariate analysis showed that age, gender, depth of tumor invasion, perforation/penetration, extent of lymph node dissection, number of examined lymph nodes, and POAC were significant independent prognostic factors for OS. Univariate analyses showed no significant difference in DFS or OS for CEA mRNA-positive and mRNA-negative cases.ConclusionThis study showed that gender, depth of tumor invasion, extent of lymph node dissection, number of examined lymph nodes, and lack of use of POAC were significant independent prognostic factors in stage II colon cancer.

Ozanimod-exposed Patients with Ulcerative Colitis Undergoing Total Colectomy Exhibit Unique Lymph Node Histological Changes.

Ozanimod regulates lymphocyte egress from the spleen and lymph nodes into the systemic circulation. The histological changes which occur in the lymph nodes of patients on ozanimod is unknown. This retrospective study included patients with ulcerative colitis [UC] undergoing total colectomy for treatment-refractory disease who received ozanimod, and a cohort of patients with UC undergoing colectomy who did not have ozanimod exposure. Histology of the lymph nodes from the mesentery of colectomy specimens was reviewed and multiple features were scored by experienced pathologists. Six [13%] ozanimod-treated patients with UC required surgery for treatment-refractory disease. Colectomy specimen data were available for five patients [one patient had surgery at an outside centre]. Lymph node specimens from six control patients with UC who had colectomy were examined. Histological examination of lymph nodes showed that patients treated with ozanimod had significantly greater extent of dilated sinuses [p = 0.03] and greater degrees of sinus histiocytosis [p = 0.03] compared with control patients. In addition, there was a trend towards more Castleman-like angiotrophic hyperplasia, plasma cell infiltration, and subcortical interfollicular expansion in ozanimod-treated patients. This study identifies unique histological changes in the lymph nodes of patients with UC treated with ozanimod. The presence of sinus histiocytosis and dilated sinuses is in keeping with the known mechanism of action of ozanimod, and suggests that blocking lymphocyte egression from lymph nodes was insufficient to ameliorate disease severity in these patients. The possibility of Castleman-like features, identified in several of the cases, needs to be further investigated.

Inadequate lymph node examination leads to misclassification and affects survival in resected pancreatic ductal adenocarcinoma

Inadequate lymph node examination leads to misclassification and affects survival in resected pancreatic ductal adenocarcinoma