Technique Of Lymphadenectomy Research Articles

Neoadjuvant chemotherapy for gastric cancer: update.

Neoadjuvant chemotherapy has recently received increasing attention in an attempt to increase the rate of complete tumor resections, combat systemic metastases, and prolong survival in patients with gastric cancer. The available data indicate that neoadjuvant chemotherapy is feasible and does not increase postoperative morbidity and mortality. Compared to the results that can today be obtained with primary resection and lymphadenectomy, however, preoperative chemotherapy has so far failed to show a clear increase in the rate of complete tumor removal in patients with resectable gastric cancer. In patients with locally advanced or unresectable gastric cancer, preoperative chemotherapy may cause substantial reduction in locoregional tumor mass and thus increase the resection rate. This finding appears to translate into a survival benefit for those who respond to chemotherapy and have subsequent complete tumor resection. Because of severe shortcomings in the study design of the published reports, definite conclusions cannot be drawn from the available studies. Randomized controlled prospective trials are therefore clearly warranted. Exact pretherapeutic tumor staging, standardized resection and lymphadenectomy techniques, diligent evaluation of the resected specimen, and close follow-up are essential when designing these trials to identify subgroups of patients who may benefit from neoadjuvant chemotherapy for gastric carcinoma.

Early-stage squamous cell and adenocarcinoma of the cervix

Articles on early-stage squamous cell and adenocarcinoma of the cervix published between August 1990 and July 1991 are reviewed. A new monoclonal antibody used to distinguish endocervical from endometrial differentiation is described, as well as a histochemical means of distinguishing in situ from invasive adenocarcinoma. In vitro and in vivo studies of cell lines immortalized with human papillomavirus DNA are described with a discussion of the mechanism of the development of malignancy. An animal model to test and develop an anti-human papillomavirus vaccine is presented. The epidemiology of adenocarcinoma is also reviewed, and the development of invasive carcinoma after conservative therapy or conization for dysplasia is discussed. Computed tomography scanning has been found to be no more accurate than examination for staging of early cervical cancer. Several studies in the review period have evaluated risk factors for recurrent disease in patients treated for early-stage cervical cancer, including a prospective surgical pathologic study by the Gynecologic Oncology Group. The optimal treatment of early stage I adenocarcinoma of the cervix is discussed, comparing the efficacy of primary surgical therapy with the efficacy of radiation therapy. The risk of ovarian metastases in patients with early-stage cervical cancer is very low for both squamous cell and adenocarcinoma. The surgical technique and efficacy of laparoscopic pelvic lymphadenectomy for patients with early-stage cervical cancer are discussed. Lateral transposition of the ovaries at the time of radical hysterectomy for cervical cancer has significant potential benefits but also risks. Finally, surveillance methods that detect recurrent cervical cancer after treatment for early-stage disease are discussed.

Nerve-sparing Technique for Retroperitoneal Lymphadenectomy in Testis Cancer

The technique of retroperitoneal lymphadenectomy has been modified by measures to identify and preserve the postganglionic sympathetic fibers and their ganglia and thus preserve antegrade ejaculation. Thorough bilateral lymphadenectomy can still be performed, but this technique avoids the principal morbidity of this operation except in some patients with bulky disease.

Role of Lymphadenectomy in the Treatment of Bladder Cancer

The value of pelvic lymphadenectomy in patients undergoing cystectomy for bladder cancer continues to remain controversial. It has been the authors' policy to perform a complete bilateral pelvic lymphadenectomy on all patients for whom radical cystectomy is potentially curative. They discuss distribution and incidence of nodal disease, limits of pelvic node dissection, the technique of pelvic lymphadenectomy, and their results.

Retroperitoneal lymphadenectomy for germ cell tumor of testis in association with horseshoe kidney

Four of 310 patients (1.3 per cent) who underwent retroperitoneal lymphadenectomy for germ cell tumor of the testis at Memorial Sloan-Kettering Cancer Center (MSKCC) between July, 1971, and July, 1978, had incidental finding of horseshoe kidney. The management of these 4 patients is presented, with specific reference to the surgical technique of retroperitoneal lymphadenectomy. Retroperitoneal lymphadenectomy can be performed by adequate mobilization of the renal isthmus without the need of its division.

Adjuvant chemotherapy in embryonal carcinoma of the testis.

There are only a few randomized studies on adjuvant chemotherapy in nonseminomatous germ cell testicular tumors. This is so because these tumors are rare (3.1 in every 100,000 in the United States) and because it is difficult to form a cooperative group among institutes that have differing ideas on the technique of lymphadenectomy, the value of irradiation, and the type of chemotherapy that must be used in testicular tumors. However, embryonal carcinoma of the testicles, which are very sensitive to chemotherapy, are a choice tumor for studying adjuvant chemotherapy.

Second Congress of the European Association of Urology Lymphadenectomy in Urological Cancer

This report on a round table which took place at the 2nd Congress of the EAU in Prague, concerns the indications and techniques of lymphadenectomy in tumours of the testis, prostate and bladder as well as cancers of the kidney, penis and upper urinary tract.