Standard Lymph Node Dissection Research Articles

Standardize the surgical technique and clarify the oncologic significance of robotic D3-D4 lymphadenectomy for upper rectum and sigmoid colon cancer with clinically more than N2 lymph node metastasis.

The territory of D3-D4 lymphadenectomy for upper rectal and sigmoid colon cancer varies, and its oncological efficacy is unclear. This prospective study aimed to standardize the surgical technique of robotic D3-D4 lymphadenectomy and clarify its oncologic significance. Patients with upper rectal or sigmoid colon cancer with clinically suspected more than N2 lymph node metastasis were prospectively recruited to undergo standardized robotic D3-D4 lymphadenectomy. Immediately postsurgery, the retrieved lymph nodes were mapped to five N3-N4 nodal stations: the inferior mesenteric artery, para-aorta, inferior vena cava, infra-renal vein, and common iliac vessels. Patients were stratified according to their nodal metastasis status to compare their clinicopathological data and overall survival. Univariate and multivariate analyses were performed to determine the relative prognostic significance of the five specific nodal stations. Surgical outcomes and functional recovery of the patients were assessed using the appropriate variables. A total of 104 patients who successfully completed the treatment protocol were assessed. The standardized D3-D4 lymph node dissection harvested sufficient lymph nodes (34.4±7.2) for a precise pathologic staging. Based on histopathological analysis, 28 patients were included in the N3-N4 nodal metastasis-negative group and 33, 34, and nine patients in the single-station, double-station, and triple-station nodal metastasis-positive groups, respectively. Survival analysis indicated no significant difference between the single-station nodal metastasis-positive and N3-N4 nodal metastasis-negative groups in the estimated 5-year survival rate [53.6% (95% CI: 0.3353-0.7000) vs. 71.18% (95% CI: 0.4863-0.8518), P=0.563], whereas patients with double-station or triple-station nodal metastatic disease had poor 5-year survival rates (24.76 and 22.22%), which were comparable to those of AJCC/UICC stage IV disease than those with single-station metastasis-positive disease. Univariate analysis showed that the metastatic status of the five nodal stations was comparable in predicting the overall survival; in contrast, multivariate analysis indicated that common iliac vessels and infra-renal vein were the only two statistically significant predictors (P<0.05) for overall survival. Using a robotic approach, D3-D4 lymph node dissection could be safely performed in a standardized manner to remove the relevant N3-N4 lymphatic basin en bloc, thereby providing significant survival benefits and precise pathological staging for patients. This study encourages further international prospective clinical trials to provide more solid evidence that would facilitate the optimization of surgery and revision of the current treatment guidelines for such a clinical conundrum.

Quality control of lymph node dissection for locally advanced gastric cancer

Numerous studies have confirmed that D2 lymphadenectomy is the standard surgery for locally advanced gastric cancer. Standardized lymph node dissection plays a crucial role in ensuring surgical quality and efficacy. It is recommended to perform D2 lymph node dissection according to the 6th edition of the Japanese gastric cancer treatment guidelines. For lymph nodes beyond the scope of D2 lymph node dissection, such as No.10, 13, 14v, 16 and mediastinal lymph nodes, selective D2+ lymph node dissection can be performed, which may be advantageous for some patients. Currently, omentectomy is the standard surgical procedure for locally advanced gastric cancer. However, the clinical significance of gastrectomy with preservation of the greater omentum requires further validation through large-scale clinical trials. Standardized ex vivo lymph node dissection is important for accurate postoperative staging, and it is recommended to harvest more than 30 lymph nodes to avoid staging deviation.

Optimal extent of lymph node dissection for high-risk gastric cancer stratified by a national clinical database risk calculator.

For patients with gastric cancer, a well-balanced treatment that considers both oncological aspects and surgical risk is demanded. This study aimed to explore the optimal extent of lymph node dissection (LND) for patients with gastric cancer according to surgical risk, stratified by the risk calculator system produced by the Japan National Clinical Database (NCD). We retrospectively evaluated 187 patients who underwent radical gastrectomy for gastric cancer. Using the median predicted anastomotic leak rate obtained by the NCD risk calculator as the cutoff value, we classified 97 and 90 patients as having high and low risks, respectively. In low-risk patients, although limited LND reduced the postoperative intraabdominal infectious complications (IAIC), multivariate analysis revealed standard LND as an independent prognostic factor that improved Relapse-free survival (RFS). In high-risk patients, the rates of postoperative IAIC and RFS were similar between standard and limited LND. Pancreatic fistula was not observed in the limited dissection group. Limited LND might be the optimal treatment strategy for patients with gastric cancer with high surgical risk.

Long-Term Outcome of Proximal Gastrectomy for Upper-Third Advanced Gastric and Siewert Type II Esophagogastric Junction Cancer Compared With Total Gastrectomy: A Propensity Score-Matched Analysis

BackgroundThis study aimed to investigate the oncologic long-term safety of proximal gastrectomy for upper-third advanced gastric cancer (AGC) and Siewert type II esophagogastric junction (EGJ) cancer.MethodsThe study enrolled patients who underwent proximal gastrectomy (PG) or total gastrectomy (TG) with standard lymph node (LN) dissection for pathologically proven upper-third AGC and EGJ cancers between January 2007 and December 2018. Propensity score-matching with a 1:1 ratio was performed to reduce the influence of confounding variables such as age, sex, tumor size, T stage, N stage, and tumor-node-metastasis (TNM) stage. Kaplan-Meier survival analysis was performed to analyze oncologic outcome. The prognostic factors of recurrence-free survival (RFS) were analyzed using the Cox proportional hazard analysis.ResultsOf the 713 enrolled patients in this study, 60 received PG and 653 received TG. Propensity score-matching yielded 60 patients for each group. The overall survival rates were 61.7 % in the PG group and 68.3 % in the TG group (p = 0.676). The RFS was 86.7 % in the PG group and 83.3 % in the TG group (p = 0.634). The PG group showed eight recurrences (1 anastomosis site, 1 paraaortic LN, 1 liver, 1 spleen, 1 lung, 1 splenic hilar LN, and 2 remnant stomachs). In the multivariate analysis, the operation method was not identified as a prognostic factor of tumor recurrence.ConclusionThe patients who underwent PG had a long-term oncologic outcome similar to that for the patients who underwent TG for upper-third AGC and EGJ cancer.

Laparoscopic D2+ lymph node dissection in patients with obesity and gastric cancer: A retrospective study.

D2 lymph node dissection is widely used in laparoscopic radical gastrectomy for gastric cancer, and its efficacy and safety are known for patients with obesity. Currently, D2+ lymph node dissection is also applied to certain patients with gastric cancer of later stages. Due to the high difficulty of D2+ surgery, it is more challenging to perform on patients with obesity. There is currently limited research on the efficacy and safety of D2+ surgery in obese patients with gastric cancer. The present study aimed to retrospectively analyze the clinical data of patients undergoing laparoscopic radical gastrectomy for gastric cancer admitted to a single gastroenterology department. Patients with a body mass index ≥25 kg/m2 were included in the study. A total of 149 patients were selected as the research subjects and divided into two groups. The observation group comprised 74 patients who underwent D2+ lymph node dissection, while the control group comprised 75 patients who underwent standard D2 lymph node dissection. The surgical performance, postoperative recovery and postoperative complications of the two groups were compared. The results showed that the rates of conversion to open surgery in the D2+ and D2 groups were 5.4% (4/74) and 2.7% (2/75), respectively, and were not significantly different. The duration of surgery in the D2+ group (282.55±23.02 min) was significantly longer than that in the D2 group (271.45±20.05 min). The mean number of lymph node dissections in the D2+ group was 28.57±7.19, which was significantly higher than that in the D2 group (25.29±6.41). No statistically significant differences in intraoperative blood loss, time to first flatus, postoperative hospitalization days, total hospitalization expenses or postoperative complications was detected between the two groups. There were no deaths in either group within the 30-day perioperative period. In addition, there was no significant difference in the 3-year overall survival rate between the two groups, while the 5-year overall survival rate of the D2+ group was significantly higher than that of the D2 group. For obese patients with gastric cancer, D2+ surgery may increase the duration of surgery and slightly increase intraoperative blood loss compared with standard D2 radical surgery, but does not increase the incidence of postoperative complications. Moreover, D2+ surgery increases the number of lymph node dissections and improves the 5-year survival rate of patients. Therefore, it may be concluded that laparoscopic D2+ lymph node dissection is safe and feasible for obese patients with gastric cancer.

A comparative analysis of perioperative complications and biochemical recurrence between standard and extended pelvic lymph node dissection in prostate cancer patients undergoing radical prostatectomy: a systematic review and meta-analysis.

Pelvic lymph node dissection (PLND) is commonly performed during radical prostatectomy (RP) for prostate cancer staging. This study aimed to comprehensively analyze existing evidence compare perioperative complications associated with standard (sPLND) versus extended PLND templates (ePLND) in RP patients. A meta-analysis of prospective studies on PLND complications was conducted. Systematic searches were performed on Web of Science, Pubmed, Embase, and the Cochrane Library until May 2023. Risk ratios (RRs) were estimated using random-effects models in the meta-analysis. The statistical analysis of the data was carried out using Review Manager software. Nine studies, including 3 randomized clinical trial and 6 prospective studies, with a total of 4,962 patients were analyzed. The meta-analysis revealed that patients undergoing ePLND had a higher risk of partial perioperative complications, such as lymphedema (I2=28%; RR 0.05; 95% CI, 0.01-0.27; P<0.001) and urinary retention (I2=0%; RR 0.30; 95% CI, 0.09-0.94; P=0.04) compared to those undergoing sPLND. However, there were no significant difference was observed in pelvic hematoma (I2=0%; RR 1.65; 95% CI, 0.44-6.17; P=0.46), thromboembolic (I2=57%; RR 0.91; 95% CI, 0.35-2.38; P=0.85), ureteral injury (I2=33%; RR 0.28; 95% CI, 0.05-1.52; P=0.14), intraoperative bowel injury (I2=0%; RR 0.87; 95% CI, 0.14-5.27; P=0.88), and lymphocele (I2=0%; RR 1.58; 95% CI, 0.54-4.60; P=0.40) between sPLND and ePLND. Additionally, no significant difference was observed in overall perioperative complications (I2=85%; RR 0.68; 95% CI, 0.40-1.16; P=0.16). Furthermore, ePLND did not significantly reduce biochemical recurrence (I2=68%; RR 0.59; 95% CI, 0.28-1.24; P=0.16) of prostate cancer. This analysis found no significant differences in overall perioperative complications or biochemical recurrence between sPLND and ePLND, but ePLND may offer enhanced diagnostic advantages by increasing the detection rate of lymph node metastasis.

Sentinel lymph node biopsy in patients with breast cancer. Experience in implementing at the regional level. Priority issues

Background. Despite the fact that sentinel lymph node biopsy (SLNB) in breast cancer patients has become a routine diagnostic procedure, it is still of great interest to researchers, since the priority issues of choosing methodology, equipment, technology, and stages of use are still being discussed. Although all obstacles to this technique implementation into routine clinical practice have been eliminated, SLNB in locally advanced breast cancer is still rarely used. We describe the experience of implementing SLNB in Nizhny Novgorod Regional Clinical Oncology Dispensary. We also discuss organizational, tactical, and practical approaches aimed to minimize the number of errors in technical terms, as well as to choose a multidisciplinary approach to the development of regulations for the examination and treatment of patients with locally advanced breast cancer.Aim. To assess the efficacy of SLNB implementation for patients with locally advanced breast cancer at the regional level.Materials and methods. This study included 500 patients with invasive (T1–2) breast cancer with clinically negative sentinel lymph nodes of all immunohistochemical subtypes that had undergone SLNB and histological examination. Sentinel lymph nodes were visualized using the radioisotope colloid 99mTc-Nanotop. We present the implementation algorithm for this procedure into routine clinical practice and evaluate short-term results.Results. A total of 500 patients have undergone SLNB. The first 30 cases were considered pilot cases, where all patients positive for sentinel lymph nodes additionally underwent standard axillary lymph node dissection. We observed a 100 % concordance of histological results. Then the surgery was routinely performed for all patients from this category. The assessment of short-term surgical outcomes demonstrated significant improvement of the postoperative period, reduced frequency of postoperative complications (persistent seroma of the axillary area to 2.85 %), reduced length of hospital stay (by 52.7 %) and improved functional and aesthetic results in the majority (&gt;62 %) of patients.Conclusion. Our algorithm of SLNB use in patients with breast cancer in routine clinical practice at the regional level allows for rapid method implementation, reduced length of hospital stay, better functional and aesthetic results, and lower incidence of persistent seroma of the axillary area.

Chinese expert consensus on celiac lymphadenectomy during open/minimally invasive esophagectomy (2023 edition)

Surgical resection remains the cornerstone of the multidisciplinary treatment for patient with localized esophageal cancer. Lymphadenectomy is a pivotal step of radical esophagectomy, which is advanced technique required. Although the consensus on mediastinal lymph node dissection in the radical esophagectomy had been published in China, no agreement or consensus are available on the abdominal lymph node dissection. Based on the latest guidelines or consensuses, available clinical evidence, and agreements from Chinese expert panel of abdominal lymph node dissection in the radical esophagectomy, Chinese Society of Esophageal Cancer, China Anti-cancer Association organized experts to discuss and write this consensus. The expert consensus focuses on the key points of and makes recommendations for surgical approach, extent of lymphadenectomy, quality control and complication management for abdominal lymph node dissection in the radical esophagectomy in China. Applying a standard and efficient abdominal lymph node dissection in the radical surgical resection for patient with esophageal cancer is important and indispensable.

Is solo indocyanine green-guided lymphadenectomy a feasible alternative to standard pelvic lymph node dissection?

Is solo indocyanine green-guided lymphadenectomy a feasible alternative to standard pelvic lymph node dissection?

Effect of different lymph node dissection methods on the number of lymph nodes detected and prognosis in gallbladder cancer.

At present, the extent of lymph node dissection (LND) for radical gallbladder cancer (GBC) is still controversial, and there is no evidence that LND improves prognosis, however, the latest guidelines for GBC recommend that removal of more than 6 lymph nodes facilitates staging of regional lymph nodes. The aim of this study is to investigate the effect of different LND methods on the number of lymph nodes detected and assess the prognostic factors during radical resection of GBC. This study retrospectively analyzed 133 patients (46 men and 87 women; average age: 64.01, range: 40-83 years) who underwent radical resection of GBC in a single center between July 2017 and July 2022, of which 41 underwent fusion lymph node dissection (FLND) and 92 underwent standard lymph node dissection (SLND). Baseline data, surgical results, number of LNDs, and follow-up data were analyzed. Each patient was followed up every 3 months. The total number of lymph nodes detected after the operation was 12.00 ± 6.95 versus 6.10 ± 4.71 (P < .05). The number of positive lymph nodes detected was (mean) 1.85 versus 0.78 and (percentage) 15.45% versus 12.83% (P < .05). Postoperative complications (8 vs 23, P > .05). The progression-free survival was 13 versus 8 months, the median survival time was 17 versus 9 months (P < .05). This study concluded that FLND can increase the detection rate of total lymph nodes and positive lymph nodes after surgery, which can prolong the survival time of patients.

Extended versus standard pelvic lymph node dissection yields no difference in 3-year biochemical recurrence rates.

extended pelvic lymph node dissection (ePLND) increases the detection rate of lymph node positive prostate cancer compared to a standard pelvic lymph node dissection (sPLND). However, improvement of patient outcomes remains questionable. Here we report and compare 3-year postoperative PSA recurrence rates between patients that underwent sPLND versus ePLND at the time of prostatectomy. 162 patients received a sPLND (which involvedremoval of periprostatic, external iliac, and obturator lymph nodes bilaterally), and 142 patients received an ePLND (which involved removal of periprostatic, external iliac, obturator, hypogastric, and common iliac nodes bilaterally). Decision to undergo ePLND versus sPLND at our institution was changed in 2016 based on the National Comprehensive Cancer Network guideline. The median follow-up time was 7 and 3years for sPLND and ePLND patients, respectively. All node-positive patients were offered adjuvant radiotherapy. Kaplan-Meier analysis was carried out to assess the impact of a PLND on early postoperative PSA progression-free survival. Subgroup analyses were done for node-negative and node-positive patients, as well as Gleason score. Gleason score and T stage were not significantly different between patients who received an ePLND and sPLND. The pN1 rate for ePLND and sPLND were 20% (28/142) and 6% (10/162), respectively. There was no difference in the use of adjuvant treatments in the pN0 patients. Significantly, more ePLND pN1 patients received adjuvant androgen deprivation therapy (25/28 vs. 5/10 P=0.012) and radiation (27/28 vs. 4/10 P=0.002). Yet, no difference in biochemical recurrence between ePLND and sPLND was observed (P=0.44). This remained true in subgroup analyses of node-positive (P=0.26), node-negative (P=0.78), Gleason Score 6-7 (P=0.51), and Gleason Score 8-10 (P=0.77). PLND provided no additional therapeutic benefit, even though ePLND patients were significantly more likely to have node-positive disease and undergo adjuvant treatment, compared to a sPLND.

Practice change: No benefit of extended lymphadenectomy at radical cystectomy in patients with muscle invasive bladder cancer

For many decades, extended pelvic lymph node dissection has been an integral part during radical cystectomy for patients with muscle invasive bladder cancer. This practice was based on large retrospective meta-analyses suggesting an oncologic benefit to an extended dissection. This mini review and meta-analysis includes the two available randomized trials in the current literature. Therefore, it can be considered as the strongest level of evidence regarding the prognostic benefit of an extended pelvic lymphadenectomy. Based on current randomized data, standard pelvic lymph node dissection up to the level of iliac bifurcation is sufficient, and extension of the dissection above this level does not provide any additional oncologic benefit.

MP46-19 THE ROLE OF EXTENDED VERSUS STANDARD LYMPHADENECTOMY LYMPH NODE DISSECTION IN CLINICALLY LYMPH NODE-POSITIVE BLADDER CANCER

You have accessJournal of UrologyCME1 Apr 2023MP46-19 THE ROLE OF EXTENDED VERSUS STANDARD LYMPHADENECTOMY LYMPH NODE DISSECTION IN CLINICALLY LYMPH NODE-POSITIVE BLADDER CANCER Markus Von Deimling, Andrea Mari, Alberto Bianchi, Moritz Maas, Renate Pichler, Malte W. Vetterlein, Francesco Del Giudice, Karl H. Tully, Luca Afferi, Marco Moschini, Ekaterina Laukhtina, Michael Rink, Shahrokh F. Shariat, and Benjamin Pradere Markus Von DeimlingMarkus Von Deimling More articles by this author , Andrea MariAndrea Mari More articles by this author , Alberto BianchiAlberto Bianchi More articles by this author , Moritz MaasMoritz Maas More articles by this author , Renate PichlerRenate Pichler More articles by this author , Malte W. VetterleinMalte W. Vetterlein More articles by this author , Francesco Del GiudiceFrancesco Del Giudice More articles by this author , Karl H. TullyKarl H. Tully More articles by this author , Luca AfferiLuca Afferi More articles by this author , Marco MoschiniMarco Moschini More articles by this author , Ekaterina LaukhtinaEkaterina Laukhtina More articles by this author , Michael RinkMichael Rink More articles by this author , Shahrokh F. ShariatShahrokh F. Shariat More articles by this author , and Benjamin PradereBenjamin Pradere More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003292.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The appropriate extent of lymph node dissection (LND) at radical cystectomy for bladder cancer (BCa) is still controversial. In particular, patients with clinical evidence of locoregional lymph node metastasis (cN+) may benefit from an extended LND. In this study, we investigated the effect of extended versus standard LND on survival outcomes in patients with cN+ BCa. METHODS: We queried our retrospective, multi-institutional database to identify all patients who underwent upfront RC with standard (internal, external iliac, and obturator lymph nodes) or extended LND (additionally common iliac and presacral lymph nodes) for cT2-4N1-3M0 BCa. We excluded censored patients with a follow-up <3 months and all patients who received preoperative chemotherapy. The primary objective was to assess recurrence-free survival (RFS) after RC and the distribution of recurrences (local vs. distant). Secondary endpoints comprised overall (OM) and cancer-specific mortality (CSM). The Kaplan-Meier method and cumulative incidence curves accounting for competing risks were used to delineate survival outcomes graphically. We assessed the impact of the LND template on RFS, OM, and CSM on uni- and multivariable regression analyses. This study was IRB-approved (ref. no. 1480/2022). RESULTS: Of 370 patients, 232 underwent standard and 138 extended LND. In total, 182 experienced cancer recurrence, 190 died with 140 dying from BCa. Median follow-up of patients alive was 32 months, and median time to recurrence was 8 months. Patients who underwent an extended LND were significantly younger (mean 73 vs. 68 years, p=0.001), had more frequent cN3-stage (1.7% vs. 9.4%), and more positive lymph nodes removed (median 1.0 vs. 2.0, p=0.02). 114 patients received adjuvant treatment with no difference between LND groups. There was no difference in the distribution of recurrences (in total, 32 locoregional, 103 distant, and 18 both) between the groups. On survival analyses, we did not find a difference in RFS (p=0.17), OM (p=0.91), or CSM (p=0.07) when stratified by the LND template. On multivariable analyses, adjusted for age, gender, comorbidities, pathological T- and N-stage, type of urinary diversion, surgical margins, and receipt of adjuvant treatment, the LND template was not independently associated with survival outcomes. CONCLUSIONS: In patients with cN+ BCa, extended LND did not results in an improved RFS, OM, or CSM compared to standard LND. The results of the ongoing prospective SWOG 1101 trial are urgently awaited. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e640 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Markus Von Deimling More articles by this author Andrea Mari More articles by this author Alberto Bianchi More articles by this author Moritz Maas More articles by this author Renate Pichler More articles by this author Malte W. Vetterlein More articles by this author Francesco Del Giudice More articles by this author Karl H. Tully More articles by this author Luca Afferi More articles by this author Marco Moschini More articles by this author Ekaterina Laukhtina More articles by this author Michael Rink More articles by this author Shahrokh F. Shariat More articles by this author Benjamin Pradere More articles by this author Expand All Advertisement PDF downloadLoading ...

Different lymph node dissection ranges during radical prostatectomy for patients with prostate cancer: a systematic review and network meta-analysis

ObjectiveThe purpose of this network meta-analysis was to compare the effectiveness and adverse effects of limited, standard, extended, and super-extended pelvic lymph node dissection (PLND) following radical prostatectomy.MethodsThis study followed the PRISMA 2020 statement. Clinical trials were searched from three electronic databases, including PubMed, the Cochrane Library, and Embase from the database’s inception to April 5, 2022. The lymph node-positive rate, biochemical recurrence-free rate, lymphocele rate, thromboembolic rate, and overall complication rate were compared by meta-analysis. Data analyses were performed using R software based on the Bayesian framework.ResultsSixteen studies involving 15,269 patients were included. All 16 studies compared the lymph node-positive rate; 5 studies compared the biochemical recurrence-free rate; 10 studies compared the lymphocele rate; 6 studies compared the thromboembolic rate, and 9 studies compared the overall complication rate. According to Bayesian analysis, the lymph node-positive rate, lymphocele rate, and overall complication rate were significantly associated with the extension of the PLND range. The limited, extended, and super-extended PLND templates showed a similar but lower biochemical recurrence-free rate and a higher thromboembolic rate than the standard template.ConclusionsThe extension of the PLND range is associated with an elevated lymph node-positive rate; however, it does not improve the biochemical recurrence-free rate and correlates with an increased risk of complications, especially lymphocele. The selection of the PLND range in clinical practice should consider the oncological risk and adverse effects.Trial registrationPROSPERO (CRD42022301759).

Frequency of lymph node metastasis according to tumor location in clinical T1 early gastric cancer: supplementary analysis of the Japan Clinical Oncology Group study (JCOG0912).

The frequency of lymph node metastases per lymph node site in early gastric cancer has not been well clarified from the data based on prospective studies. This exploratory analysis aimed to determine the frequency and location of lymph node metastases in clinical T1 gastric cancer using the data from JCOG0912 to investigate the validity of the extent of standard lymph node dissection defined in Japanese guidelines. This analysis included 815 patients with clinical T1 gastric cancer. The proportion of pathological metastasis was identified for each lymph node site per tumor location (middle third and lower third) and four equal parts of the gastric circumference. The secondary aim was identification of the risk factor for lymph node metastasis. Eighty-nine patients (10.9%) had pathologically positive lymph node metastases. Although the overall frequency of metastases was low (0.3-5.4%), metastases were widely located in each lymph node sites when primary lesion was in the middle third of the stomach. No. 4sb and 9 showed no metastasis when primary lesion was in the lower third of the stomach. Lymph node dissection of metastatic nodes resulted in a 5-year survival in more than 50% of patients. A tumor greater than 3cm and a T1b tumor were associated with lymph node metastasis. This supplementary analysis demonstrated that nodal metastasis from early gastric cancer is widely and disorderly not depending on the location. Thus, systematic lymph node dissection is necessary to cure the early gastric cancer.

The application value of the anatomy and treatment of inferior mesenteric artery in laparoscopic surgery for left-sided colorectal cancer

The inferior mesenteric artery (IMA) is the blood supply vessel in the left colorectal cancer (CRC) and is the focus for clinicians during the operation of the left-sided CRC. Different IMA treatment methods will affect the blood supply of the anastomotic bowel after the operation, thus affecting the prognosis. Nevertheless, the individual anatomical variation rate of IMA is great. It is the crucial to perform precise high/low ligation and standardized lymph node dissection according to the anatomical characteristics of IMA in laparoscopic radical resection of left-sided CRC. In the present study, we reviewed the effects of IMA length, classification, the relationship with adjacent vessels and ureter, and different IMA treatments on the prognosis of patients.

The progression of the extent of lymph node dissection in radical resection of pancreatic head cancer

Pancreatic cancer is a malignant tumor of digestive system with poor prognosis,and surgical resection is still the only hope for a radical cure. Although the current consensus and guidelines describe in detail the standard and extended range of lymph node dissection,the selection of specific range of lymph node dissection and its impact on prognosis are still controversial. Current studies have not only proposed some improved extent of lymph node dissection, such as total mesopancreas excision and Heidelberg triangle dissection, but also suggested different extent of lymph node dissection for ventral and dorsal pancreatic head cancer. In addition, the prognosis of pancreatic head cancer in uncinate process and non-uncinate process is different after para-aortic lymph node dissection, which is worthy of further study. Neoadjuvant therapy or conversion therapy provides more surgical opportunities for patients with pancreatic cancer. For these patients, Heidelberg triangle dissection has potential value in improving prognosis. This paper summarizes the exploration and latest progress of standard and extended lymph node dissection, lymph node dissection of specific site of pancreatic head cancer and the extent of lymph node dissection after neoadjuvant/transformation therapy in recent years.

The role of extended versus standard lymphadenectomy lymph node dissection in clinically lymph node-positive bladder cancer

The role of extended versus standard lymphadenectomy lymph node dissection in clinically lymph node-positive bladder cancer

Reconceptualizing the clinicopathological features, locoregional therapy and prognostic factors of occult breast cancer in the era of molecular subtyping

ABSTRACT To evaluate the clinical features, molecular subtypes, therapeutic strategies, and prognostic factors of occult breast cancer (OBC). Patients with T0-3/N1-3/M0 breast cancer diagnosed in 2010–2018 (n = 114,303, including 691 with OBC) were retrieved from the Surveillance, Epidemiology, and End-Results (SEER) database. The endpoints were overall survival (OS) and breast cancer-specific survival (BCSS). Compared with non-OBC, OBC presented significantly more adverse clinicopathological prognostic features. More patients with OBC underwent breast-conserving treatment (BCT) and less had axillary lymphadenectomy (ALD). Outcomes were more favorable in OBC cases compared with non-OBC cases (p = .002 for OS, p = .002 for BCSS). Triple-negative (TNBC) and HER2-enriched were the subtypes with the worst prognosis in OBC (p < .05). Prognosis was better for triple-negative OBC compared with the same subtype of non-OBC. N-stage was not a strong prognostic indicator of OBC (p > .05 for OS). Cases who underwent systemic chemotherapy alone without surgery had the worst prognosis among OBC patients. For locoregional therapy, mastectomy and radiotherapy could confer survival advantage; standard axillary lymph node dissection (ALND) and positive lymph node dissection (PLND) contributed notably to OS in OBC patients. Both OS and BCSS were better in OBC cases compared with non-OBC. Systemic chemotherapy alone without surgery is not appropriate for OBC treatment, and mastectomy plus standard axillary surgery is recommended. Patients with hormone receptor-positive and low burden of axillary lymph node metastasis may be spared from radiotherapy after undergoing standard axillary lymphadenectomy.

Observation on the Effect of Spontaneous Ventilation Single-Port Thoracoscopy and Conventional Thoracoscopy on T Lymphocyte Subsets and Inflammatory Factors in Patients with Non-Small Cell Lung Cancer

Objective: To explore the effects of two types of surgical approaches, spontaneous ventilation single-port thoracoscopy and conventional thoracoscopy, on T lymphocyte subsets and inflammatory factors in patients with non-small cell lung cancer. Methods: Fifty-eight patients with non-small cell lung cancer who underwent surgery in the Affiliated Hospital of Hebei University from January 2020 to December 2021 were selected as the study subjects. All of them underwent standard lobectomy and lymph node dissection. Among them, 32 patients who underwent spontaneous ventilation single-port thoracoscopy were included in the study group, while 26 patients who underwent conventional thoracoscopy were included in the control group. The perioperative related indices, lung function, immune factor levels, and inflammatory factor levels were compared between the two groups. Results: In the study group, the perioperative incision length, intraoperative blood loss, operation time, and number of lymph node dissections were 4.28 ± 2.01, 77.89 ± 12.02, 87.21 ± 16.11, and 20.69 ± 4.45, respectively. In the control group, the perioperative incision length, intraoperative blood loss, operation time, and number of lymph node dissections were 6.32 ± 2.45, 84.98 ± 16.98, 95.88 ± 14.89, and 21.45 ± 4.36, respectively. There was no statistical difference between the study group and the control group in the number of lymph node dissections and intraoperative blood loss; the lung function in the study group was significantly better than that in the control group; the levels of T cell subsets CD4+, CD8+, CD4+/CD8+, CD16+CD56+ of the study group were 46.36 ± 5.87, 30.98 ± 4.12, 1.19 ± 0.23, and 17.41 ± 6.25, respectively, while those in the control group were 35.78 ± 4.12, 34.14 ± 3.87, 1.04 ± 0.24, and 12.45 ± 5.56, respectively; the levels of immunoglobulin IgG, IgM, and IgA of the study group were 10.45 ± 2.14, 1.21 ± 0.24, and 1.26 ± 0.25, respectively, while those of the control group were 8.78 ± 1.78, 1.06 ± 0.12, and 1.06 ± 0.26, respectively, with statistical differences; the levels of CRP, IL-6, IL-8, and TNF-? of the control group were 21.87 ± 4.26, 98.01 ± 9.58, 111.03 ± 9.96, and 123.05 ± 9.77, respectively, while those of the study group were 19.47 ± 3.89, 89.12 ± 8.96, 104.32 ± 9.12, and 112.98 ± 9.16, respectively, in which the comparison was statistically significant. Conclusion: In the surgical treatment of non-small cell lung cancer, spontaneous ventilation single-port thoracoscopic surgery has several advantages, which include less trauma and bleeding. It reduces the impact of surgical trauma on the immune function of the body, improves the postoperative lung function and inflammatory stress of the body, as well as accelerates the recovery of patients. It is an alternative to open lung lobectomy for the treatment of lung cancer.