Management Of Lymph Node Metastases Research Articles

Thyroglossal duct carcinoma.

The purpose of this paper is to review the presentation and management of thyroglossal duct carcinoma. Recent articles have analyzed the value of preoperative investigation and have addressed some of the controversies in the management of such tumors; in particular, the optimal surgical management of the thyroid gland, as well as optimal management of lymph node metastases, the role of thyroid suppression therapy, and radioactive iodine therapy. Thyroglossal duct carcinoma is uncommon, occurring in approximately 1% of all thyroglossal duct cysts. It is often diagnosed incidentally after surgical excision. Ninety-four percent of carcinomas are of thyroid origin, with most being papillary in nature, and 6% are of squamous cell origin. Incidentally discovered, well-differentiated thyroid carcinoma of the thyroglossal duct, in the presence of a clinically and radiologically normal thyroid gland, can be managed adequately by the Sistrunk operation. Those patients with more advanced disease require more aggressive treatment. This may include a total thyroidectomy with or without neck dissection in addition to the Sistrunk operation, followed by radioactive iodine therapy and thyroid-stimulating hormone suppression. The prognosis is generally excellent with adequately treated disease.

Papillary Thyroid Carcinoma: Justification for Total Thyroidectomy and Management of Lymph Node Metastases

Papillary thyroid carcinoma (PTC) is the most common epithelial thyroid tumor and comprises approximately 80% of all thyroid cancers. In this article, the authors discuss the data showing that total thyroidectomy is the treatment of choice of clinically significant PTC, and review an algorithm for the management of lymph node metastases. Although the prognosis for patients with PTC is generally good, appropriate surgical management (total thyroidectomy plus 131I and life-long TSH suppression) can further reduce recurrence and cancer death rates significantly.

Utilization of intraoperative electroneurography to understand the innervation of the trapezius muscle.

The radical neck dissection is an operation for the management of lymph node metastases from primary sites involving the oral cavity, larynx, and other areas of the head and neck. In this procedure, the spinal accessory nerve is removed along with other structures. In modified neck dissection the spinal accessory nerve is preserved. Patients undergoing the modified neck dissection have had variable functional outcomes from little or no pain or disability, to significant muscle dysfunction. Our group hypothesized that patients with good functional outcomes following modified neck dissection may have had motor contributions from C2, C3, or C4 branches, while those with less favorable outcomes did not. To demonstrate the presence of motor input and its significance both from the spinal accessory nerve and the branches of the cervical plexus, we utilized intraoperative electroneurography. We find that although there is motor contribution from C2, C3, and C4 to the trapezius muscle, it was not consistent or significant.

Prognostic significance and surgical management of lymph node metastasis in gastric cancer

Regional lymph node metastasis is a critical prognostic factor in gastric cancer, and extended lymph node dissection and routine microscopic examination of all resected nodes could potentially provide accurate information regarding lymph node status. On the other hand, the therapeutic value of extended lymph node dissection is controversial. While retrospective and prospective nonrandomized comparative studies have shown that extended lymph node dissection significantly improves the survival rate, two prospective randomized trials have failed to demonstrate the efficacy of extended dissection, although the number of patients in these studies was limited. There is a further, ongoing, trial involving a larger series of patients; the final results of this study should help to determine whether extended lymph node dissection is of therapeutic or merely prognostic value in gastric cancer.

Prognostic significance and surgical management of lymph node metastasis in gastric cancer

Prognostic significance and surgical management of lymph node metastasis in gastric cancer

Surgical Management for Lymph Node Recurrence of Resected Fibrolamellar Carcinoma of the Liver: A Case Report

Fibrolamellar carcinoma of the liver (FLC), which is very rare in Japan, is reported to be frequently accompanied by lymph node metastasis in Europe and the United States. We describe a 22-year-old man with recurrent FLC in the lymph nodes after undergoing partial hepatectomy. He underwent a second operation for removal of recurrent lymph node tumors in the mediastinum and abdominal cavity one year after initial surgery. However, a third operation became necessary seven months later, because of recurrence in a lymph node in the abdominal cavity. We discuss the management of lymph node metastasis from FLC.

Management of lymph node metastases in breast cancer and gastric cancer.

The management of regional lymph node metastases in breast cancer and gastric cancer is reviewed. Regional lymph node metastasis is a critical prognostic factor in these diseases, but there is an apparent discrepancy in the efficacy of regional lymph node dissection between them. A number of prospective randomized clinical trials have demonstrated that regional lymph node dissection improves the regional control of breast cancer, but does not improve the survival. On the other hand, only retrospective or prospective comparative studies have shown that extended lymph node dissection significantly improves the survival in gastric cancer. Although the discrepancy in the regional lymph node dissection between breast and gastric cancers has been explained by differences in their biological behaviors, caution must still be exercised in drawing conclusions from these norandomized studies.

Type‐oriented therapy for gastric cancer effective for lymph node metastasis: Management of lymph node metastasis using activated carbon particles adsorbing an anticancer agent

Activated carbon particles are taken selectively up by lymphatics when injected into the tissues and visualize regional lymph nodes colored black. Furthermore, carbon particles adsorb a large amount of the anticancer agent mitomycin C (MMC) on their surface and release the drug reversibly. Using these properties of activated carbon particles, we have applied it for lymph node dissection and chemotherapy of lymph node metastasis. After injection of carbon particles, regional lymph nodes of the stomach were found to be black; blackened lymph nodes extending widely from perigastric to para-aortic nodes were identified from other structures. Four hundred and twenty-four patients with gastric cancer were treated with this method for lymph node metastasis during 1984-1988. Involved nodes were generally colored in high incidence, about 70% of involved ones except for highly positive nodes, which was the same as noninvolved nodes. In highly positive nodes, the colored incidence was decreased to about 48%. The cumulative 5-year survival rate of the patients treated with this series was 74.6%, which was significantly higher than the figures without this method.

Radiation therapy of periaortic node metastases in cancer of the uterine cervix and endometrium.

Thirty-eight women with surgically confirmed periaortic lymph node metastases from cervical or endometrial carcinoma received radiation therapy. The 5-year observed actuarial survival and relapse-free rates were 42% and 41%, respectively. Concomitant peritoneal metastases conferred a bleak prognosis. There were no differences in survival as a function of site of origin, histologic characteristics, or bulk of periaortic metastases. Earlier stage disease tended to have a higher probability of cure. Morbidity was acceptable. The results confirmed the importance of radiation therapy in the management of lymph node metastases in uterine cancer.