Resected Nodes Research Articles

Efficacy and complications of endoscopic thoracoscopic versus laparoscopic radical esophagectomy in esophageal cancer treatment: A retrospective study.

To evaluate the efficacy and postoperative complications of endoscopic thoracoscopic and laparoscopic radical esophagectomy compared to open surgery in esophageal cancer treatment. This retrospective study included 103 esophageal cancer patients admitted from August 2018 to March 2022, divided into observation (endoscopic surgery) and control (open surgery) groups. We compared intraoperative parameters, postoperative outcomes, immune function, and one-year overall survival (OS). Intraoperative bleeding volume, the retention time of chest tube, postoperative fasting time, and hospital stay in the observation group were smaller than those in the control group (P < .05). The differences were not statistically significant (P > .05) when comparing operative time, the number of intraoperative blood transfusion cases, and the rate of operating room extubation in these 2 groups. The differences were not statistically significant when comparing the amount of resected lymph nodes and the positive rate of incisal edge in these 2 groups (P > .05). There was no statistically significant difference in the complication rates such as pneumonia, pleural effusion, pneumothorax, pulmonary embolism, anastomotic fistula, the leakage of thoracic duct, the injury of RLN and arrhythmia in these 2 groups (P > .05). At 7 days postoperatively, the CD4+ and CD4+/CD8+ in the observation group and the control group were smaller than the preoperative ones in their same groups, and they were larger in the observation group than those in the control group (P < .05); There was no statistically significant difference on the CD8+ in the observation group and the control group at 7 days postoperatively compared with the preoperative ones in their same groups (P > .05). The 1-year postoperative OS rate was 81.63% (40/49) in the observation group and 72.22% (39/54) in the control group, and the difference was not statistically significant when comparing the OS rates of these 2 groups (P = .238, HR = 0.622, 95% CI = 0.279-1.385). Endoscopic thoracoscopic and laparoscopic esophagectomy offers less invasive treatment with significant short-term benefits and better preservation of immune function in esophageal cancer patients, making it a safe and effective surgical option.

The role of radiomics analysis in the assessment of renal nodules on CT

PurposeTo develop a radiomics model for the characterization of renal nodules on CT.MethodsPatients who underwent surgical resection of renal nodules, with preoperative CT (LightSpeed VCT, GE) with contrast agent (Iopamidol 370; 1.5 ml/kg) and availability of a histopathological report, were retrospectively included. Renal lesions were segmented by two radiologists in consensus, in the arterial phase on the axial section with greater diameter. The radiomics analysis was performed with validated software (PyRadiomics on Syngo.via Frontier, Siemens) by applying normalization, resampling (1,1,1), setting bin width (15), and applying padding (2). The extracted features were used for training and testing machine learning models (random forest and support vector machine (end point: clear cell carcinoma, ccRCC).Results45 patients were included (mean age 56 years; 34/45 ccRCC). SVM e RF models obtained an AUC of 0.84 and accuracy of 0.87 and 0.80, respectively, in the testing phase.ConclusionRadiomics analysis is feasible and effective in the characterization of renal lesions on CT.

Unusual Pattern of Spread of High-Grade Serous Fallopian Tubal Carcinoma in a Woman with BRCA1 Gene Mutation

A 40-year-old woman presented with chronic watery vaginal discharge for one-month and right pelvic pain radiating to the right flank for 2 weeks. Physical and pelvic examination revealed a right pelvic mass. Computerized tomography and magnetic resonance of whole abdomen revealed a 6-cm of heterogeneous mass at the right adnexa and a larger mass of 8-cm with internal cystic portions compressing on the inferior vena cava. Her serum cancer antigen (CA) 125 elevated to 540 U/ml. Surgical intervention revealed a right fallopian tube mass with an intact serosal surface, several enlarged pelvic and para-aortic nodes, and a bulky precaval node. No gross peritoneal nor other organ invasion was found. Complete surgical staging was performed by gynecologic oncologists and a surgeon, resulting in optimal surgery. Pathology revealed high-grade serous carcinoma of the right fallopian tube with metastasis to all resected nodes and a positive peritoneal cytology. Subsequent blood testing showed BReast CAncer (BRCA) 1 gene mutation. Adjuvant therapy with paclitaxel/carboplatin/bevacizumab was given for six cycles. Maintenance therapy with bevacizumab/olaparib, and periodic surveillance for other cancers, including breast magnetic resonance imaging were planned. This case presented an unusual pattern fallopian tubal cancer spread to a large precaval lymph node which was bulkier than the primary tumor. A thorough pre-operative evaluation and a surgical team specialized in cancer surgery are crucial for successful surgical management. Appropriate adjuvant treatment and follow-up for a woman with BRCA mutation were also to be emphasized.

246. EFFECT OF INTRAOPERATIVE NERVE MONITORING DURING MINIMALLY INVASIVE ESOPHAGECTOMY

Abstract Background Recurrent laryngeal nerve (RLN) lymphadenectomy is a crucial step during esophagectomy. However, it is technically demanding and associated with a significant risk of RLN injury. Despite several studies demonstrating the feasibility of intraoperative nerve monitoring (IONM) during esophageal surgery, routine utilization of IONM during minimally invasive esophagectomy has not become common, and there is limited evidence to provide robust guidance. Here, we describe our experience with IONM during minimally invasive McKeown esophagectomy. Methods Data from 115 consecutive patients who underwent bilateral RLN lymphadenectomy during thoracoscopic McKeown esophagectomy for esophageal squamous cell carcinoma (ESCC) by a single surgeon between July 2017 and November 2023 were reviewed. The cohort was divided into three groups: Group 1 (initial 23 cases without IONM), Group 2 (middle 46 cases without IONM), and Group 3 (late 46 cases with IONM). We compared the number of resected lymph nodes and the incidence of vocal cord palsy (VCP) among the three groups. Results The mean number of resected right-side RLN lymph nodes was 1.21, 2.30, and 3.28 in Groups 1, 2, and 3, respectively. A significant difference was noted between Groups 2 and 3 (p = 0.03, Kruskal-Wallis test). The mean number of resected left-side RLN lymph nodes was 1.13, 2.70, and 2.67 in Groups 1, 2, and 3, respectively. A significant difference was noted between Groups 1 and 2 (p = 0.009), but not between Groups 2 and 3. The incidence of VCP was 8.7%, 8.7%, and 10.9% in Groups 1, 2, and 3, respectively. Compared to Group 2, the utilization of IONM in Group 3 did not reduce the postoperative VCP rate (OR: 1.280, 95% CI: 0.321-5.107). Conclusions With increasing experience, the number of resected RLN lymph nodes significantly increased. However, the utilization of IONM did not further improve left-side RLN lymphadenectomy or reduce the VCP rate.

Treatment of Unsuspected T4 Non-Small Cell Lung Cancer With Additional Intrapulmonary Nodules

BackgroundThere is limited consensus on the optimal treatment for patients with non-small cell lung cancer (NSCLC) who are found to have additional intrapulmonary nodules in a different ipsilateral lobe (unsuspected pT4-Add) during surgery. This study compared outcomes of patients with unsuspected pT4-Add NSCLC after resection of the primary site tumor with or without resection of additional nodules. MethodsPatients who underwent surgery for cT1-3 N0-1 M0 NSCLC with unsuspected pT4-Add disease in the National Cancer Database (2010-2015) were included. Overall survival and short-term outcomes were compared between patients who underwent resection of only the primary tumor (“primary site resection”) and those who underwent resection of the primary tumor and additional nodules (“extended resection)” by using Kaplan-Meier analysis and propensity score matching on 10 variables. ResultsOf the 339 patients included in this study, 245 (72.3%) underwent primary site resection and 94 (27.7%) underwent extended resection. In a 2:1 variable ratio propensity score-matched analysis of 83 patients who underwent primary site resection and 42 patients who underwent extended resection, no significant difference was found in 5-year overall survival between the 2 groups. ConclusionsThe results of this national analysis suggest that in the setting of unsuspected pT4-Add NSCLC, proceeding without resection of additional nodules may confer similar overall survival for carefully selected patients with appropriate adjuvant therapy.

203. THE NUMBER OF RESECTED LYMPH NODES FROM THE UPPER MEDIASTINAL AREA PREDICTS LONG-TERM OUTCOMES OF ESOPHAGEAL CANCER AFTER MIE

Abstract Background The total number of resected lymph nodes (LNs) is an important determinant of longer survival after esophagectomy for esophageal squamous cell carcinoma (ESCC). However, resected LN counts from which areas affect long-term outcomes remain unclear. Methods: This study comprised 406 patients who underwent minimally invasive esophagectomy (MIE) at Kobe University Hospital. Resected LN counts were evaluated in the following areas: upper mediastinal (UM), middle mediastinal (MM), lower mediastinal (LM), and abdominal (Abd). Cut-off values for LN counts from each area were determined using receiver operating characteristics analysis to the survival status. Cox proportional hazards regression analyses were performed to identify prognostic factors. Results: The cut-off values for large or small numbers of resected LN counts in the UM, MM, LM, and Abd areas were 4, 8, 5, and 18 in patients with upper and middle thoracic (Ut/Mt) ESCC, respectively, and 7, 6, 5, and 24 in patients with lower thoracic (Lt) ESCC, respectively. Multivariate analysis in patients with Ut/Mt ESCC revealed that tumor invasion depth, lymph node metastasis and the resected LN count from the UM area were independent risk factors for overall survival (hazard ratio = 7.04; 95% confidence interval = 4.47-11.1, hazard ratio = 4.01; 95% confidence interval = 1.96-8.21, hazard ratio = 2.18; 95% confidence interval = 1.24-3.82, respectively). In patients with Lt ESCC, tumor invasion depth, lymph node metastasis and pulmonary complication were independent risk factors for overall survival (hazard ratio = 4.23; 95% confidence interval = 2.14-8.35, hazard ratio = 3.83; 95% confidence interval = 1.75-8.38, hazard ratio = 2.80; 95% confidence interval = 1.38-5.65, respectively). Resected LN counts from no areas were prognostic factors. Conclusions: The number of resected LNs from the UM area influenced survival outcomes of patients with Ut/Mt ESCC after MIE.

763. TEXTBOOK ONCOLOGIC OUTCOME FOLLOWING TRIMODALITY THERAPY FOR ESOPHAGEAL ADENOCARCINOMA

Abstract Background Although the concept of textbook oncologic outcome (TOO) as an emerging quality benchmark has been validated in the general surgical oncology literature, data regarding the frequency of achieving TOO and its impact on subsequent survival outcomes in patients with esophageal adenocarcinoma (EAC) who undergo trimodality therapy remain undefined. Methods Patients with adenocarcinoma of the esophagus/gastroesophageal junction (GEJ, Siewert I/II) who underwent neoadjuvant chemoradiation and esophagectomy at a single institution (2000-2022) were retrospectively identified. Patients undergoing salvage resection were excluded. TOO was defined according to a published consensus definition: length of stay (LOS) ≤14 days, R0, ≥20 resected lymph nodes, no anastomotic leak (any grade), no Clavien-Dindo (CD) grade ≥3 complications, no hospital or intensive care unit (ICU) readmission, and no reoperation. Multivariable logistic regression was used to identify clinicopathologic features associated with TOO. Multivariable Cox regression and landmark analyses were used to quantify the association between TOO and OS. Results Of 1138 patients, TOO was observed in 38.2% (435): 90.9% (1034) R0, 60.9% (693) ≥20 lymph nodes, 89.9% (1023) no anastomotic leak, and 98.4% (1120) no in-hospital mortality. Features independently associated with reduced odds of TOO included: cervical anastomosis (OR 0.50, P=0.001), preoperative delay ≥90 days after neoadjuvant therapy (OR 0.62, P=0.004), induction chemotherapy (OR 0.74, P=0.039), coronary artery disease (OR 0.67, P=0.043). Among patients who underwent esophagectomy &amp;lt;90 days after neoadjuvant therapy and survived ≥30 days, TOO was independently associated with improved OS (HR 0.80, P=0.018). TOO remained associated with improved OS using 90-day (P=0.014) and 120-day (P=0.037) landmarks. Conclusions Although TOO is difficult to achieve following trimodality therapy for EAC, it is strongly associated with improved long-term overall survival. As such, further efforts are warranted to explore the utility of TOO as a quality benchmark in EAC patients and to validate its impact across varying practice settings.

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.

563. CURRENT AND PROPOSED TREATMENT STRATEGIES FOR LOCALLY ADVANCED ESOPHAGEAL ADENOCARCINOMA OF THE ESOPHAGOGASTRIC JUNCTION

Abstract Background The optimal treatment strategy for locally advanced esophageal adenocarcinoma of the esophagogastric junction (AEG) is still unclear, and no consensus exists whether to treat it as an esophageal cancer or as a gastric cancer, which would include adjuvant therapy. The purpose of this study was to determine the optimal lymph node dissection, considering lymph node metastases and to develop a strategy for treatment that includes adjuvant therapy to improve the survival rate. Methods The patients were selected from a retrospective study by the Department of Surgery, Institute of Gastroenterological Surgery, Tokyo Women’s Medical University, that was conducted from 1990 to 2019. We studied 88 cases of advanced AEG in patients who underwent surgery with lymph node dissection. We retrospectively investigated the patient characteristics, pathological findings, surgical procedures, optimum extent of lymph node dissection, location of metastatic lymph nodes, recurrence pattern, and survival curves. Results Positivity for H. pylori was 29.8%. Barrett esophagus was found in 33%. Barrett esophagus was low. The calculated index for each nodal station was in stations 1, 2, 3, 7, 11 and 110 for 3-year survival and in stations 1, 2, 3 and 7 for 5-year survival. The proportion with undifferentiated histological type was high. The surgical approach underwent lower esophagectomy + proximal gastrectomy. Double-tract reconstruction was performed in 45%. Adjuvant (postoperative) chemotherapy was given to 51% patients. Preoperative (neoadjuvant) chemoradiotherapy was 17%. The 5-year overall survival rates were 24%. Conclusion We found that the optimal lymph node resection consists of the inferior mediastinum (No. 110), the lesser curvature (Nos. 1, 3, 7), No. 2, and No 11. When esophageal involvement was &amp;gt; 40 mm, we performed esophagectomy including upper thoracic lymph nodes. We were not satisfied with the result of surgical treatment including lymph node dissection alone in advanced AEG. We will recommend nab-paclitaxel combined with radiotherapy for advanced AEG to improve the survival rate.

566. SUPERIOR MEDISTINAL LYMPHADENECTOMY IN PRONE POSITION UTILIZING 3D-ASSISTED THORACOSCOPY. A NOVEL APPROACH

Abstract Introduction Routine lymphadenectomy during esophagectomy includes 2-field lymphadenectomy for distal-esophageal or esophago-gastric junction adenocarcinoma. Superior mediastinal lymphadenectomy (SML) refers to extended 2-field lymphadenectomy (right or left para-tracheal nodes) or total mediastinal lymphadenectomy. The exact benefits of (SML) have long been debated, but with the evolution of prone position 3D-assisted thoracoscopy favorable outcomes can be achieved in the hand of experts. Aim This study aims to describe our surgical technique of 3D-assisted thoracoscopic SML during minimally invasive esophagectomy in prone position. Material and Methods SML included right paratracheal nodes and lymph nodes (LNs) along the right recurrent laryngeal nerve throughout its mediastinal route (including the paratracheal-retrocaval compartment) in cases of extended 2-field lymphadenectomy, as well as left paratracheal nodes and LNs along the left recurrent laryngeal nerve during total mediastinal lymphadenectomy. Results Among the identified eligible cases (n=30), there was no mortality at 30- or 90-post-operative days. No anastomotic or chyle leaks were observed. Pulmonary complications occurred in 15% of patients; right recurrent laryngeal nerve palsy was noted in one patient (3.3%). The median number of resected LNs was 45, with a median count of 12 SML LNs. Conclusions Although limited by a small cohort sample, this study suggests that minimally invasive esophagectomy with SML may offer some benefits in terms of oncological outcomes without significant additional morbidity. https://wetransfer.com/downloads/6329dbd1f817d7e492f8905291f946e120240309180637/42ee79017067b59a4a73138377d9d95620240309180649/f28a32

Impact of imaging features on selecting limited lymph node resection for cT1N0M0 lung cancer.

Controversy still exists in the medical community regarding the performance of limited mediastinal lymphadenectomy (LML) in early-stage lung cancer. The objective of this study was to identify predictors of mediastinal lymph node (mLN) status and analyze its role in guiding surgical strategy. A retrospective cohort study was conducted on 2,834 surgical patients with peripheral cT1N0M0 non-small cell lung cancer between 2016 and 2018. Logistic regression was employed to identify predictors of N2 metastasis. Prognosis was compared between groups and independent prognostic factors were identified using Kaplan-Meier and multivariate Cox analysis. There were 2,126 patients with systematic mLN dissection and 708 with LML. The multivariate analysis showed that N2 metastasis were associated with tumor size and consolidation tumor ratio (CTR). Patients in group A, with CTR >0.5 and tumor size ≤1 cm or CTR ≤0.5, had a significantly lower rate of N2 metastasis compared to those in group B, with CTR >0.5 and tumor size >1 cm (14.2% vs. 0.2%, P<0.001). Additionally, LML demonstrated comparable recurrence-free survival (RFS) and overall survival (OS) in group A, but a worse prognosis in group B compared to systematic lymph node dissection (SND). Furthermore, multivariate Cox regression analysis indicated that SND (vs. LML) was a favorable prognostic predictor for patients in group B [RFS: hazard ratio (HR) =0.71, P=0.005; OS: HR =0.66, P=0.01]. But univariate analysis in group A showed no significant difference in prognosis between SND and LML (RFS: P=0.24; OS: P=0.10). The combination of CTR and tumor size can predict mLN metastasis and procedure-specific outcome (SND vs. LML). This information may assist surgeons in identifying suitable candidates for LML.

Prognostic impact of lymph node invasion levels in patients with bladder cancer undergoing radical cystectomy and pelvic lymphadenectomy.

Extranodal extension in metastatic lymph nodes (LNs) is a poor prognostic factor in bladder cancer (BC). Furthermore, cancer invasion levels in sentinel LNs are associated with prognosis in melanoma. The present study aimed to evaluate the LN invasion level, defined as the extent of cancer invasion in anatomical and immunological LN substructures, and compare it with the pathological node (pN) stage of the tumor-node-metastasis staging system in BC. A total of 98 patients with BC who underwent radical cystectomy and pelvic lymphadenectomy were retrospectively assessed. The LN invasion level was classified as follows: Level 0, no cancer cell within the resected LNs; Level 1, cancer cells confined to intracapsular lymph vessels and subcapsular or transverse sinuses; Level 2, cancer cells infiltrating the cortex, paracortex or medulla; and Level 3, cancer cells infiltrating or beyond the LN capsule. The proportion of patients with Levels 0, 1, 2 and 3 was 70.4% (69/98), 8.2% (8/98), 14.3% (14/98) and 7.1% (7/98), respectively. Kaplan-Meier survival curves of recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) with LN invasion levels better stratified outcome patient when using Levels 1-3 compared with pN1-3. In addition, LN invasion levels better predicted RFS, CSS and OS, in comparison with the pN stage (c-index of 0.672 vs. 0.646, 0.688 vs. 0.665, and 0.702 vs. 0.661, respectively). Finally, multivariate analysis revealed that the predictive accuracy of the model integrating pathological tumor (pT) stage and LN invasion levels in RFS, CSS and OS was greater than that of the conventional model that included pT and pN stage (c-index of 0.723 vs. 0.703, 0.710 vs. 0.694, and 0.725 vs. 0.692, respectively). In conclusion, the model with LN invasion levels accurately predicted the prognosis of patients with BC after radical cystectomy and pelvic lymphadenectomy.

CORRELATION OF INGUINAL LYMPH NODE NUMBER AND VOLUME WITH LOWER EXTREMITY LYMPHEDEMA SEVERITY

There are very limited studies on the relationship of inguinal lymph node number and volume correlated with lower extremity lymphedema severity. In this IRB-approved retrospective study, patients who obtained an MRI for lower extremity lymphedema and who did not have lymph node resection or biopsy were identified. The MRI images were used to determine the number and volume of inguinal lymph nodes for each limb in addition to fat and fluid-based scoring using a validated grading system. Wilcoxon signed-rank tests were used to compare the greater-affected limbs with the lesser-affected limbs. The spearman- rank correlation was performed on a ‘per limb’ basis for MRI-based scoring and clinical parameters with ipsilateral lymph node number and volume and for differences between the limbs. A total of 32 patients were included. The greater-affected limb had higher MRI fluid scores (median (interquartile range) = 3 (3 - 3) vs. 0 (0 - 1), (p &amp;lt; 0.01) relative to the contralateral limb and had a median fat asymmetry score of 2 (1 - 3). On the per-limb analysis, lymph node number and volume inversely correlated with total MRI scores (ρ = -0.47, p &amp;lt; 0.01 for node number and volume). The difference of lymph node number and volume correlated with MRI score difference (node number: ρ = -0.66, p &amp;lt; 0.01; node volume: ρ = - 0.64, p &amp;lt; 0.01) and perometer difference (node number: ρ = -0.58, p &amp;lt; 0.01; node volume: ρ = - 0.59, p &amp;lt; 0.01). Inguinal lymph node number and volume inversely correlate with lower extremity edema presence and severity.

Laparoscopic Left Side Duodenum Adenocarcinoma Resection (III-IV Segment): A Step-By-Step Surgical Technique.

Nonampullary duodenal adenocarcinoma (NDA) accounts for approximately 5% of all gastrointestinal cancers. Complete surgical resection (R0) with regional draining lymph node removal is mandatory as treatment to potentially cure nonampullary duodenal cancer or to achieve long-term survival. According to existing literature, minimally invasive surgery has been reported to be safe and oncologically equivalent in pancreaticoduodenectomy for pancreatic and duodenal cancer. We describe a fully laparoscopic approach for the left-side adenocarcinoma of the duodenum "left-side" is defined with reference to the mesenteric vessels (III-IV segment). For the first time in literature, this multimedia paper describes a fully laparoscopic complete resection (R0) of the left side of the duodenum (III-IV segment) with locoregional lymph node resection. The main steps of the procedure are described using the concept of the critical view of safety. Reconstruction of intestinal continuity was ensured by full intracorporeal anastomosis. Through the tips and indications presented in this article, we supply a guide to the minimally invasive approach and increase operating surgeons' familiarity with such a complex procedure.

Successful radical surgery for lymph node metastasis in a patient with hepatocellular carcinoma following atezolizumab plus bevacizumab combination therapy: a case report and literature review.

A woman in her early 80 s was followed up in our hospital for chronic hepatitis C after viral eradication. We detected rapid-growing lymph node metastasis of hepatocellular carcinoma (HCC) after treatment with transcatheter arterial chemoembolization and/or radiofrequency ablation. We found that the metastasis was operable, but the size and location of the metastasis obliged the patient to receive pancreatoduodenectomy, which was too invasive. Then we initiated systemic chemotherapy to perform radical minimally invasive surgery. We treated the patient with 3 weekly cycles of atezolizumab 1200mg plus bevacizumab 15mg/kg. The patient tolerated the treatment well, and treatment-emergent adverse events included deterioration of hypertension and increased uric protein. After a total of 4 cycles of therapy, abdominal computed tomography findings showed that the metastasis evidently decreased, and a complete response was achieved based on the Revised Response Evaluation Criteria in Solid Tumors (RECIST) guidelines (version 1.1). Seventeen days later, the metastasis was dissected. Subsequently, we confirmed that there was no pathological metastatic lesion in the resected lymph node. Our case is the first report of successful application of the radical therapy to lymph node metastasis of HCC via combination therapy with atezolizumab/bevacizumab.

Proposal for standardization of laparoscopic D3 lymphadenectomy for right colon cancer.

This study presents a laparoscopic surgical protocol for right hemicolectomy and D3 lymphadenectomy (R-D3L) in right colon cancer and reports the oncological outcomes based on a prospective series. The study comprises two phases. In the first phase, a dynamic demonstration of the R-D3L surgical protocol is provided through textual explanation, illustrations, and edited surgical videos. The protocol emphasizes technical steps such as dissection of the embryological plane of the right mesocolon, high tie of ileocolic vessels, surgical trunk of Gillot dissection, and high tie of superior right colic vein (SRCV). In the second phase, a prospective observational study was conducted involving patients undergoing R-D3L surgery with this protocol between July 2015 and July 2021. Demographic, perioperative, and postoperative variables are analyzed, along with anatomopathological variables and oncological outcomes. A total of 33 patients were analyzed. Median operative time was 202min. Perioperative bleeding occurred in 6%. Postoperative complications were mild (Clavien-DindoIII in 2%). Postoperative ileus was observed in 15%. No anastomotic dehiscence was reported. The median postoperative stay was 7days. The median number of resected lymph nodes was 26, with 27% having positive nodes and 70% were classified as stage T3 or T4. After a median follow-up of 45months, local recurrence, distant recurrence, and carcinomatosis rates were 0%. Mortality rate from other causes was 9%. The surgical protocol shown in the present study could help in the implementation of this technique in those units that consider it appropriate.

The therapeutic value of ipsilateral supraclavicular lymphadenectomy in locally advanced breast cancer: A review.

The treatment of isolated ipsilateral supraclavicular lymph node metastasis for locally advanced breast cancer has always been a controversial issue for breast surgeons. However, with the further understanding of the metastasis and treatment of breast cancer, it is now considered to be a locally advanced disease, and there is a new debate on the treatment of isolated ipsilateral supraclavicular lymph node metastasis. The author reviewed the relevant literature and briefly discussed the clinical significance of supraclavicular lymph node resection in patients with locally advanced breast cancer presenting with isolated ipsilateral supraclavicular lymph node metastasis.

Transanal total mesorectal excision: short- and long-term results of four certified colorectal cancer centers in Germany

BackgroundTransanal total mesorectal excision (TaTME), a novel approach for treating low rectal cancer, holds promise. However, concerns exist in certain countries about their oncologic safety due to less-than-optimal outcomes on global studies. This research seeks to evaluate the long-term oncologic outcomes focusing on local recurrence rate and overall survival after TaTME surgery in Germany.Patients and methodsThis study analyzed data from patients who underwent elective TaTME surgery between 2014 and 2021 in four certified colorectal cancer centers in Germany. Primary endpoints were 3-year local recurrence rate and local recurrence-free survival (LRFS). Secondary outcomes encompassed overall survival (OS), operative time, completeness of local tumor resection, lymph node resection, and postoperative complications.ResultsA total of 378 patients were analyzed (mean age 61.6 years; 272 males, 72%). After a median follow-up period of 2.5 years, 326 patients with UICC-stages I–III and tumor operability included in survival analyses. Local recurrence was observed in 8 individuals, leading to a 3-year cumulative local recurrence rate of 2.2% and a 3-year LRFS rate of 88.1%. The 3-year OS rate stood at 88.9%. Within 30 days after surgery, anastomotic leakage occurred in 19 cases (5%), whereas a presacral abscess was present in 12 patients (3.2%).ConclusionTaTME proves effective in addressing the anatomical and technical challenges of low rectal surgery and is associated with pleasing short- and long-term results. However, its safe integration into surgical routine necessitates sufficient knowledge and a previously completed training program.

Occult gastric carcinoma with microsatellite instability diagnosed 10 years after excision of metastatic lymph node: a case report

BackgroundSuprapancreatic lymph node metastasis is one of the usual routes for gastric cancer. However, it is rare for the primary lesion to be found several years after resection of the suprapancreatic metastatic lymph node. This is a report of occult gastric carcinoma with microsatellite instability diagnosed 10 years after excision of a metastatic lymph node.Case presentationA 55-year-old female presented with suprapancreatic lymph node swelling during a medical examination. Gastroscopy revealed no malignancy. We performed an excisional biopsy via laparotomy and histologically suspected metastatic cancer of unknown origin. After nine and a half years, we detected early gastric cancer by gastroscopy and performed a distal gastrectomy. The gastric tumor was pathologically similar to the previous suprapancreatic tumor. Immunohistochemical examination revealed that both the stomach and suprapancreatic lymph node exhibited microsatellite instability, suggesting that the two lesions were of the same origin.ConclusionsThis case is considered valuable because there have been no previous reports of gastric cancer with characteristics of high microsatellite instability in which the primary tumor was identified a long time after resection of metastatic lesions.

Surgical management strategy for metastatic cervical lymph nodes surrounding the carotid artery in head and neck squamous cell carcinoma

Objective: To explore the surgical intervention strategy for metastatic cervical lymph nodes surrounding the carotid artery in head and neck squamous cell carcinoma. Methods: A total of 62 patients with advanced head and neck tumors and carotid wrap by disease treated in Department of Otorhinolaryngology and Head and Neck Surgery, the Affiliated BenQ Hospital of Nanjing Medical University between June 2019 and December 2023 were reviewed, of whom 9 patients presented with metastatic squamous cell carcinoma in cervical lymph nodes of unknown primary or with no recurrence of primary lesion and all the 9 patients were males, aged from 48 to 79 years old, with≤level 2 of Eastern Cooperative Oncology Group-Performance Status (ECOG-PS). Radiographically common carotid artery (CCA) and/or internal carotid artery (ICA) were surrounded by≥270° with tumor. All the 9 patients received implantation of covered stent in carotid artery and radical resection of metastatic cervical lymph nodes. The success rate, complications, surgery-related complications, local recurrence rate, quality of life (QOL) and overall survival (OS) were analyzed. The QOL of patients was compared by paired rank sum test, and P<0.05 indicated statistically significant difference. The OS was analyzed by Kaplan-Meier. Results: The success rate of stent implantation was 100%, with no implantation-related complications. R0 resection was performed in 8 cases and R1 resection in 1 case. The QOL of patients after surgery was improved, and the improvements in "pain", "mood" and "anxiety" were statistically significant(Z values were -2.236, -2.460 and -2.200, respectively, and all P values were<0.05). Follow-up was 1-18 months, with a median of 7 months, and 1 case was lost to follow-up. Local recurrence occurred in 3 patients with an incidence of 37.5% (3/8). OS was 59.9% at 12 months after surgery. Conclusion: Implantation of covered stent in carotid artery combined with radical resection is an effective method for the treatment of cervical lymph node metastasis.