Node Dissection Research Articles

Laparoscopic surgery for rectal cancer with extensive retroperitoneal lymph node dissection.

Laparoscopic surgery for rectal cancer with extensive retroperitoneal lymph node dissection.

Novel Intraprostatic MR-Guided Implantation of Multidrug-Eluting Microdevice for Testing of Systemic Therapy Agents In Situ: Proof of Concept in Intermediate-Risk and High-Risk Prostate Cancer.

The purpose of this study was to assess safety and feasibility of percutaneous MR-guided placement of an implantable microdevice (IMD) to evaluate in situ intratumor response to multiple pharmacologic agents in men with intermediate-risk and high-risk localized prostate cancer. Biocompatible IMDs measuring 750 µm in diameter and 5 mm in length were prepared with 20 reservoirs containing candidate drug and drug combinations including second-generation androgen inhibitors, PARP inhibitors, PD-1 inhibitors, and conventional chemotherapy. Men with intermediate-risk or high-risk localized prostate cancer and MRI-visible lesions were enrolled. Up to 4 IMDs were placed using a transperineal approach into MRI-visible tumors 2 days before planned radical prostatectomy. After radical prostatectomy, the IMDs and a small segment of surrounding tumor tissue were removed and sectioned, stained, and analyzed for tissue drug response by a variety of pharmacodynamic markers. Fourteen patients were enrolled: 7 (50%) with intermediate-risk and 7 (50%) with high-risk localized prostate cancer. A total of 53 IMDs were implanted (mean 3.8 per patient), and 49 IMDs (92%) were successfully retrieved. All men underwent uncomplicated robotic-assisted radical prostatectomy and bilateral pelvic lymph node dissection 2 days after IMD placement. There were no severe adverse events. Pathological examination of the tissues adjacent to the IMDs demonstrated differential drug response within patients and between patients. Limitations include small sample size. A multidrug IMD can be safely placed percutaneously into MRI-visible lesions before radical prostatectomy, enabling assessment of tumor-specific local response to multiple agents simultaneously within the tumor's normal stromal environment to guide targeted systemic therapy.

ASO Visual Abstract: Omission of Axillary Lymph Node Dissection in Patients with Residual Nodal Disease After Neoadjuvant Chemotherapy.

ASO Visual Abstract: Omission of Axillary Lymph Node Dissection in Patients with Residual Nodal Disease After Neoadjuvant Chemotherapy.

Postchemotherapy Robot-Assisted Retroperitoneal Lymph Node Dissection for Metastatic Testicular Cancer: Initial Experience at a Brazilian Oncology Center

Abstract Introduction Testicular cancer is the most common neoplasm in men aged 20 to 40 years. Retroperitoneal lymph node dissection plays an essential role in the treatment of such patients. Conventional open surgery has a complication rate of 30 to 36%. Some case series have demonstrated that a robot-assisted technique presented safety, oncological efficacy, and yielded lower complication rates. We retrospectively evaluated peri- and postoperative outcomes of robot-assisted retroperitoneal lymph node dissection after chemotherapy performed in patients at Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil. Materials and Methods The present study included all patients who underwent postchemotherapy robot-assisted retroperitoneal lymph node dissection for the treatment of metastatic testicular cancer at INCA. Results From August 2020 to November 2021, 5 robot-assisted retroperitoneal lymph node dissections were performed. The mean size of the resected mass was of 7.28 cm. The mean operative time was of 307.4 minutes, and the mean length of the postoperative hospital stay was of 3.2 days. The complication rate during the first 30 days after surgery was of 0%. Conclusion Robot-assisted retroperitoneal lymph node dissection for metastatic testicular cancer demonstrated favorable perioperative outcomes, with no readmissions or complications within 30 days. Appropriate selection of patients for this technique is crucial. A larger sample with an extended follow-up is necessary for a definitive conclusion.

Prediction of non-sentinel lymph node metastases in T1–2 sentinel lymph node-positive breast cancer patients undergoing mastectomy following neoadjuvant therapy

BackgroundAxillary lymph node dissection (ALND) is the standard axillary management for breast cancer patients with positive sentinel lymph node biopsy (SLNB) after neoadjuvant therapy. Nevertheless, when that happens, the frequency of additional positive nodes is not properly evaluated. We aim to develop a prediction model to assess the frequency of additional nodal disease after a positive sentinel lymph node following neoadjuvant therapy.MethodsWe retrospectively analyzed the ultrasound and clinicopathological characteristics of breast cancer patients with 1–3 positive sentinel lymph nodes (SLN) undergoing mastectomy after neoadjuvant therapy (NAT) at our institution, and performed univariate and multivariate logistic analyses to confirm the factors affecting non-SLN metastasis. These factors were included to establish a nomogram, and the area under receiver operating characteristic curve (AUC) and decision curve analysis (DCA) were utilized to assess the validity of this model.ResultsA total of 126 breast cancer patients were ultimately included in our study, 38 (53.5%) patients were diagnosed with non-SLN metastases of all 71 patients in training set. The results of multifactorial logistic analysis suggested that lymph node metastasis ratio (LNR), short axis of lymph node and progesterone receptor (PR) were strongly associated with non-SLN metastasis. We established a nomogram using the above three variables as predictors, which yielded an area under the curve of 0.795, and validated with a favorable AUC of 0.876.ConclusionThe nomogram we constructed can accurately predict the likelihood of non-SLN metastasis in our patients with 1–3 positive SLN after NAT, which may help guide decision making regarding axillary management.

Optimization of Extended Pelvic Lymph Node Dissection Side for Prostate Cancer.

This study aimed to show the association between tumor location and laterality of positive lymph nodes by evaluating biopsy and magnetic resonance imaging (MRI) findings, and to optimize the extended pelvic lymph node dissection (ePLND) side for prostate cancer. The study enrolled patients who underwent robot-assisted radical prostatectomy with ePLND. Tumor locations were determined according to International Society of Urological Pathology grade group 4/5 in biopsies and Prostate Imaging-Reporting and Data System category 4/5 in MRI results. The concordance of tumor location lobe and positive lymph node side with the performance of tumor location-guided ePLND for positive lymph node detection was evaluated. For 301 patients who underwent ePLND at Kyushu University Hospital, tumor locations determined by biopsy and MRI findings showed no lesion in 8 (2.7%) patients, unilateral lobe in 223 (74.1%) patients, and bilateral lobe in 70 (23.3%) patients. The accuracies for detection of any and all positive lymph nodes by tumor location-guided unilateral ePLND were 99.6% and 97.3%, respectively. Among the patients at St. Luke's International Hospital, the accuracies for detection of any and all positive lymph nodes by tumor location-guided unilateral ePLND were estimated to be 99.0% and 97.3%, respectively. This study proposed tumor location-guided ePLND according to biopsy and MRI findings. This novel strategy is expected to reduce the burden of bilateral ePLND at the cost of acceptable risk of failing to detect positive lymph nodes.

Explainable machine learning model for predicting paratracheal lymph node metastasis in cN0 papillary thyroid cancer

Prophylactic dissection of paratracheal lymph nodes in clinically lymph node-negative (cN0) papillary thyroid carcinoma (PTC) remains controversial. This study aims to integrate preoperative and intraoperative variables to compare traditional nomograms and machine learning (ML) models, developing and validating an interpretable predictive model for paratracheal lymph node metastasis (PLNM) in cN0 PTC patients. We retrospectively selected 3213 PTC patients treated at the First Affiliated Hospital of Chongqing Medical University from 2016 to 2020. They were randomly divided into the training and test datasets with a 7:3 ratio. The 533 PTC patients treated at the Guangyuan Central Hospital from 2019 to 2022 were used as an external test sets. We developed and validated nine ML models using 10-fold cross-validation and grid search for hyperparameter tuning. The predictive performance was evaluated using ROC curves, decision curve analysis (DCA), calibration curves, and precision-recall curves. The best model was compared to a traditional logistic regression-based nomogram. The XGBoost model achieved AUC values of 0.935, 0.857, and 0.775 in the training, validation, and test sets, respectively, significantly outperforming the traditional nomogram model with AUCs of 0.85, 0.844, and 0.769, respectively. SHapley Additive exPlanations (SHAP)-based visualization identified the top 10 predictive features of the XGBoost model, and a web-based calculator was created based on these features. ML is a reliable tool for predicting PLNM in cN0 PTC patients. The SHAP method provides valuable insights into the XGBoost model, and the resultant web-based calculator is a clinically useful tool to assist in the surgical planning for paratracheal lymph node dissection.

Is it time to say goodbye to drainage after axillary lymph node dissection in breast cancer? A randomized clinical trial of systemic tranexamic acid combined with topical epinephrine + xylocaine versus conventional drainage.

Drainage after axillary lymph node dissection is a major cause of morbidity. We evaluated the outcomes of topical epinephrine with xylocaine + systemic tranexamic acid (EXT) after axillary lymph node dissection. The primary endpoint was the rate of seroma development. This resulted in reduced hospital stay with similar rates of seroma as drainage after axillary lymph node dissection; thereby making it possible to avoid drainage.

Deep pelvis and low visceral fat mass as risk factors for neurogenic bladder after rectal cancer surgery

BackgroundPostoperative neurogenic bladder (PONB) frequently occurs as a complication after rectal cancer surgery. This study aimed to analyze risk factors for developing PONB after rectal cancer surgery, particularly the association between pelvic anatomy and visceral fat mass.MethodsWe included 138 patients who underwent rectal resection for lower rectal cancer in our department between 2017 and 2021. PONB was defined as the need for urethral catheter reinsertion or oral medication administration for urinary retention after catheter removal with severe NB that required treatment for ≥ 60 days. We obtained visceral fat area (VFA) at the umbilical level based on a CT scan and measured five pelvic dimensions.ResultsOf the 138 patients, 19 developed PONB, with 16 being severe cases. PONB more frequently occurs in patients with a height of < 158 cm, age ≥ 70 years, surgery lasting ≥ 8 h, intraoperative bleeding volume ≥ 150 mL, lateral lymph node dissection, and narrower pelvis. It was more prevalent in cases with low VFA. Conversely, gender, body mass index (BMI), and medical history showed no significant correlations. Multivariate analysis revealed older age, prolonged surgery, and low VFA as independent risk factors for PONB. Independent risk factors for severe PONB included low VFA, older age, prolonged surgery, and deep pelvis.ConclusionLower VFA, older age, and prolonged surgery are independent risk factors for developing PONB. Additionally, a deep pelvis is an independent risk factor for severe PONB. Delicate surgical techniques should consider the risk of nerve injury in cases with low VFA and deep pelvis.

A nomogram for enhanced risk stratification for predicting cervical lymph node metastasis in papillary thyroid carcinoma patients

BackgroundCervical lymph node metastasis (CLNM) significantly impacts the prognosis of papillary thyroid carcinoma (PTC) patients. Accurate CLNM prediction is crucial for surgical planning and patient outcomes. This study aimed to develop and validate a nomogram-based risk stratification system to predict CLNM in PTC patients.MethodsThis retrospective study included 1069 patients from Zhongshan Hospital and 253 from the Qingpu Branch of Zhongshan Hospital. Preoperative ultrasound (US) data and various nodule characteristics were documented. Patients underwent lobectomy with central lymph node dissection and lateral dissection if suspicious. Multivariate logistic regression, least absolute shrinkage and selection operator (LASSO) regression, and the random forest algorithm were used to identify CLNM risk factors. A nomogram was constructed and validated internally and externally. Model performance was assessed via receiver operating characteristic (ROC) curves, calibration plots, DeLong’s test, decision curve analysis (DCA), and the clinical impact curve (CIC).ResultsSix independent CLNM risk factors were identified: age, sex, tumor size, calcification, internal vascularity, and US-reported CLNM status. The model's area under the curve (AUC) was 0.77 for both the training and the external validation sets. Calibration plots and Hosmer‒Lemeshow (HL) tests showed good calibration. The optimal cutoff value was 0.57, with a sensitivity of 58.02% and a specificity of 83.43%. Risk stratification on the basis of the nomogram categorized patients into low-, intermediate-, and high-risk groups, effectively differentiating the likelihood of CLNM, and an online calculator was created for clinical use.ConclusionThe nomogram accurately predicts CLNM risk in PTC patients, aiding personalized surgical decisions and improving patient management.

The role of radical cystectomy and lymphadenectomy in the management of bladder cancer with clinically positive lymph node involvement.

The role of radical cystectomy and pelvic lymph node dissection in muscle-invasive bladder cancer (MIBC) with clinically positive lymph nodes is debated. This review examines the role of surgery in treating patients with clinical N1 and more advanced nodal involvement (N2-N3) within a multimodal treatment approach. For clinical N1 disease, guidelines typically recommend neoadjuvant chemotherapy followed by surgery. However, for N2-N3 disease, guidelines vary. Advances in diagnostics, systemic therapies, and surgical recovery have improved the prognosis for these patients. Research is increasingly identifying MIBC patients, including those with positive nodes, who may achieve complete pathologic response and long-term survival, supporting the role of surgery even in advanced nodal stages. Managing MIBC with clinically positive lymph nodes, especially in N2-N3 disease, requires a tailored approach. While neoadjuvant chemotherapy followed by radical cystectomy is standard for N1 disease, the role of surgery in advanced nodal stages is growing because of better patient selection and treatment strategies. Emerging evidence suggests that consolidative surgery may improve outcomes in these complex cases.

Preoperative multiparametric magnetic resonance imaging based risk stratification system for predicting biochemical recurrence after radical prostatectomy

BackgroundMultiparametric magnetic resonance imaging (mpMRI) is used as a current marker in preoperative staging and surgical decision-making, but current evidence on predicting post-surgical oncological outcomes based on preoperative mpMRI findings is limited. In this study We aimed to develop a risk classification based on mpMRI and mpMRI-derived biopsy findings to predict early biochemical recurrence (BCR) after radical prostatectomy. MethodsBetween January 2017 and January 2023, the data of 289 patients who underwent mpMRI, transrectal ultrasound-guided cognitive and fusion targeted biopsies, and subsequent radical prostatectomy (RP) with or without pelvic lymph node dissection in a single center were retrospectively re-evaluated. BCR was defined as a prostate specific-antigen (PSA) ≥ 0.2 ng/mL at least twice after RP. Multivariate logistic regression models tested the predictors of BCR. The regression tree analysis stratified patients into risk groups based on preoperative mpMRI characteristics. Receiver operating characteristic (ROC)-derived area under the curve (AUC) estimates were used to test the accuracy of the regression tree–derived risk stratification tool. ResultsBCR was detected in 47 patients (16.2 %) at a median follow-up of 24 months. In mpMRI based multivariate analyses, the maximum diameter of the index lesion (HR 1.081, 95%Cl 1.015–1.151, p = 0.015) the presence of PI-RADS 5 lesions (HR 2.604, 95%Cl 1.043–6.493, p = 0.04), ≥iT3a stage (HR 2.403, 95%Cl 1.013–5.714, p = 0.046) and ISUP grade ≥4 on biopsy (HR 2.440, 95%Cl 1.123–5.301, p = 0.024) were independent predictors of BCR. In regression tree analysis, patients were stratified into three risk groups: maximum diameter of index lesion, biopsy ISUP grade, and clinical stage on mpMRI. The regression tree–derived risk stratification model had moderate-good accuracy in predicting early BCR (AUC 77 %) ConclusionStraightforward mpMRI and mpMRI-derived biopsy-based risk stratification for BCR prediction provide an additional clinical predictive model to the currently available pathological risk tools.

A Five-Year Survival Analysis of Patients with Gastric Cancer in Kerman Province

Purpose: Gastric Adenocarcinoma (GAC) is the second most frequent cause of cancer-related deaths worldwide. Determining survival and its associated prognostic factors provides a basis for further interventions to prolong survival among patients with GAC. In this study, we aimed to perform a 5-year survival analysis among GAC patients in Kerman, Iran. Materials and Methods: This retrospective multi-centric study was conducted on all patients with GAC who were referred to Afzalipour, Bahonar, and Shafa Hospitals in Kerman, Iran in 2009-2019. The 5-year survival rates were calculated based on prognostic factors, including age, histopathology, stage/grade of the tumor, metastatic status, and surgical procedures using the Kaplan-Meier analysis and log-rank test. Results: The 5-year survival rate of GAC patients with total gastrectomy was higher than those with subtotal gastrectomy (P = 0.03). Also, the 5-year survival rate was substantially improved after lymph node dissection (P &lt; 0.001). Overall survival has not been significantly different in terms of age, sex, grade, histological type, clinical T stage, lymphovascular invasion, and perineural invasion. Conclusion: Overall survival was different for the two surgical procedures and lymph node dissection. Therefore, total gastrectomy and lymph node dissection are significant independent prognostic factors for overall survival in patients with GAC.

Research progress on the distribution patterns and surgical dissection of central lymph nodes in left-sided colon cancer

Lymphatic metastasis is one of the main pathways of colorectal cancer spread and also a crucial factor in patient long-term prognosis. Lymph node dissection in the possible tumor drainage area, particularly the central group of lymph nodes at the root of the tumor-associated supplying artery, is a key and challenging aspect of surgical techniques. Currently, the patterns of lymphatic drainage and the distribution of central lymph nodes in left-sided colon cancer are not well illustrated, and there is no consensus on the necessity and extent of central lymph node dissection. This has led to significant variability in the extent of lymph node dissection among different surgeons in clinical practice, a lack of quality control standards for surgical procedures, and impacts on postoperative treatment strategy and long-term outcomes. Moreover, current research on lymphatic drainage and metastasis is primarily based on traditional anatomy, whereas individualized, precise approaches to lymph node dissection have not been realized. The application of preoperative and intraoperative lymph node imaging techniques based on functional anatomy in colorectal cancer patients is still under exploration.

Primary Malignant Melanoma of the Larynx: Case Report and Literature Review

Primary malignant melanoma of the larynx is extremely rare. This paper reports a case of a patient with primary malignant melanoma of the larynx. Preoperative laryngoscopy revealed a cauliflower-like mass in the supraglottic region, and a CT scan of the pharynx suggested laryngeal cancer with cervical lymph node metastasis. The patient underwent a total laryngectomy with lymph node dissection, and postoperative pathology confirmed a malignant melanoma in the supraglottic region of the larynx.

Prediction of High Nodal Burden in Patients With Sentinel Node–Positive Luminal ERBB2-Negative Breast Cancer

In patients with clinically node-negative (cN0) breast cancer and 1 or 2 sentinel lymph node (SLN) macrometastases, omitting completion axillary lymph node dissection (CALND) is standard. High nodal burden (≥4 axillary nodal metastases) is an indication for intensified treatment in luminal breast cancer; hence, abstaining from CALND may result in undertreatment. To develop a prediction model for high nodal burden in luminal ERBB2-negative breast cancer (all histologic types and lobular breast cancer separately) without CALND. The prospective Sentinel Node Biopsy in Breast Cancer: Omission of Axillary Clearance After Macrometastases (SENOMAC) trial randomized patients 1:1 to CALND or its omission from January 2015 to December 2021 among adult patients with cN0 T1-T3 breast cancer and 1 or 2 SLN macrometastases across 5 European countries. The cohort was randomly split into training (80%) and test (20%) sets, with equal proportions of high nodal burden. Prediction models were developed by multivariable logistic regression in the complete luminal ERBB2-negative cohort and a lobular breast cancer subgroup. Nomograms were constructed. The present diagnostic/prognostic study presents the results of a prespecified secondary analysis of the SENOMAC trial. Herein, only patients with luminal ERBB2-negative tumors assigned to CALND were selected. Data analysis for this article took place from June 2023 to April 2024. Predictors of high nodal burden. High nodal burden was defined as ≥4 axillary nodal metastases. The luminal prediction model was evaluated regarding discrimination and calibration. Of 1010 patients (median [range] age, 61 [34-90] years; 1006 [99.6%] female and 4 [0.4%] male), 138 (13.7%) had a high nodal burden and 212 (21.0%) had lobular breast cancer. The model in the training set (n = 804) included number of SLN macrometastases, presence of SLN micrometastases, SLN ratio, presence of SLN extracapsular extension, and tumor size (not included in lobular subgroup). Upon validation in the test set (n = 201), the area under the receiver operating characteristic curve (AUC) was 0.74 (95% CI, 0.62-0.85) and the calibration was satisfactory. At a sensitivity threshold of ≥80%, all but 5 low-risk patients were correctly classified corresponding to a negative predictive value of 94%. The prediction model for the lobular subgroup reached an AUC of 0.74 (95% CI, 0.66-0.83). The predictive models and nomograms may facilitate systemic treatment decisions without exposing patients to the risk of arm morbidity due to CALND. External validation is needed. ClinicalTrials.gov Identifier: NCT02240472.

Number of Retrieved Lymph Nodes during Esophagectomy Affects the Outcome of Stage III Esophageal Cancer in Patients Having Had Pre-Operative Chemo-Radiation Therapy.

Background: Lymphadenectomy plays a crucial role in the surgical management of early- stage esophageal cancer. However, few studies have examined lymphadenectomy outcomes in advanced stages, particularly in patients who initially underwent concurrent chemoradiation therapy. This retrospective study investigates the effect of lymphadenectomy in patients diagnosed with AJCC 8th-edition clinical stage III esophageal squamous cell carcinoma who received concurrent preoperative chemoradiation. Methods: Data from 1994 to 2023 were retrieved from our retrospective database. All patients underwent a uniform evaluation and treatment protocol, including preoperative concurrent chemoradiation therapy comprising cisplatin and 5-fluorouracil, followed by esophagectomy. The analysis encompassed clinical T and N stages, tumor location, tumor grade, pathological T and N stages, pathological stage, and the extent of lymph node dissection. Overall survival, "Free-To-Recurrence", and disease-free survival were assessed via Kaplan-Meier survival curves and the Cox regression model for multivariate analysis. Results: The dataset was stratified into two groups according to extent of lymph node dissection, with one group having <15 dissected nodes and the other having ≥15 dissected nodes. The group with <15 nodes exhibited a shorter "Free-To-Recurrence", worse disease-free survival, and lower overall survival. In multiple-variate analysis (Cox regression model), the number of dissected lymph nodes emerged as a significant factor influencing overall survival and freedom from recurrence. Conclusions: The quantity of lymphadenectomy is a crucial determinant for patients with AJCC 8th-edition clinical stage III esophageal squamous cell carcinoma receiving preoperative concurrent chemoradiation.

Lymphatic embolization for early post-operative lymphatic leakage after radical cystectomy for bladder cancer.

Although radical cystectomy (RC) with pelvic lymph node dissection (PLND) is the standard treatment of muscle invasive bladder cancer, it may cause lymphatic leakage. Recent studies describe lymphatic embolization (LE) as an option to manage post-operative lymphatic leakage. Hence, this study evaluated the outcome of LE in patients receiving RC and analyzed factors associated with outcomes. This was a retrospective analysis of patients who underwent LE after RC for bladder cancer between August 2017 and June 2023. The data was assessed for analysis at January 2024. The patients were divided into a clinical success group and a clinical failure group. Clinical failure was defined as the following: 1) those who required drainage catheter placement >7 days after LE, 2) those who needed re-intervention before catheter removal, and 3) those who experienced adverse events associated with LE. Logistic regression analysis was performed to identify the factors associated with outcomes of LE. We analyzed 45 patients who underwent LE after RC. Twenty-eight (62.2%) patients were identified as clinically successful. Four patients required re-embolization, but none required more than two sessions of intervention. Three patients experienced lymphatic complications after LE. In multivariable analysis, maximal daily drainage volume of >1,000 mL/day (odds ratio [OR] = 4.729, 95% confidence interval [CI]: 1.018-21.974, p = 0.047) and diabetes mellitus (DM) (OR = 4.571, 95% CI: 1.128-18.510, p = 0.033) were factors associated with LE outcome. Our results suggest LE as a potentially effective procedure for controlling post-operative lymphatic leaks after RC, with few minor side effects. Patients exceeding a daily drainage of 1,000mL/day or with a medical history of DM have a higher risk for re-intervention and clinical failure after LE.

Collateralization of the upper extremity lymphatic system after axillary lymph node dissection.

Lymphatic drainage from the arm may be altered after axillary lymph node dissection (ALND). Understanding these alterations is important as they may change standard surgical and radiation treatment in recurrent breast cancer or upper extremity skin cancers, including melanoma. Utilizing a single-institution planar and single photon emission computed tomography/computed tomography lymphoscintigraphy database, we identified patients with a diagnosis of upper extremity cutaneous melanoma from 2008 to 2023 who previously underwent ALND for cancer treatment and did not develop upper extremity cancer-related lymphedema. ALND patients were matched to control patients presenting with cutaneous melanomas at the same anatomic sites. Sentinel lymph nodes (SLNs) were compared between both groups. Of 3628 upper extremity melanoma cutaneous patients, 934 met inclusion criteria, including 22 ALND and 912 control patients. Level I axillary SLN drainage was observed in 98% of controls and 27% of ALND patients (p < 0.001). Level II axillary SLN drainage was observed in 3% of controls and 27% of ALND patients (p < 0.001). Level III axillary SLN drainage was observed in 1% of controls and 32% of ALND patients (p < 0.001). Epitrochlear SLN drainage was observed in 9% of controls and 32% of ALND patients, respectively (p < 0.046). Brachial SLN drainage was observed in 4% of controls and 23% of ALND patients (p < 0.001). Distinct changes in functional lymphatic drainage were seen between the arms of patients who previously underwent ALND versus control patients. Levels II and III axillary, epitrochlear, and brachial nodes are possible sites of metastatic disease that should be considered in patients with a prior ALND.

First case of major lung resection using the hinotori™ surgical robot system.

We performed the first case of major lung resection using the hinotori™ surgical robot system, which is a new surgical support robot system developed in Japan. A left lower lobectomy and subcarinal lymph node dissection were performed. The operation time was 3h and 5min, the cockpit time (console time) was 2h and 5min, and the blood loss was 40g. Although the hinotori™ surgical robot system requires further improvements to be used for lung cancer surgery, even in its current state, there is no difference in operability compared to the da Vinci robot, and it is possible to perform the same surgery. Further evaluation with additional cases is required in future.