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BACKGROUND AND OBJECTIVES: Observational studies suggest a link between D3 lymphadenectomy and improved disease-free survival in some colon cancer patients. However, high-quality randomized controlled trials are needed to confirm its advantage over D2 lymphadenectomy. Concerns about potential complications with D3 have limited its use outside of Japan. This study examines short-term outcomes following D3 lymphadenectomy for right-sided colon cancer compared to the established D2 procedure. Materials and Methods: This retrospective cohort single center study analyzed data on patients with right-sided colon cancer who underwent curative surgery within our healthcare trust between January 2019 and November 2022. Only patients treated by surgeons who routinely perform D3 lymphadenectomy were included for a homogenous study population. The decision to perform D3 was at the discretion of the operating surgeon. Data were collected from both paper charts and electronic medical records. Non-parametric statistical tests were used for data analysis. Results: A total of 214 patients met the criteria, with 170 undergoing D2 lymphadenectomy and 44 undergoing D3 lymphadenectomy. There were no significant differences between the groups in terms of surgery duration, blood loss, postoperative hemoglobin levels, or transfusion needs. Interestingly, the D3 group had a lower complication rate (25%) compared to the D2 group (41.2%). However, the D3 group also had a higher rate of lymph node spread (45.5% vs. 30.6% for D2) and more lymph nodes removed (19 [16, 25] vs. 23 [18, 28]). Importantly, both groups achieved similar complete tumour removal rates. Conclusions: This study suggests D3 lymphadenectomy for right-sided colon cancer might be safe with potential benefits, especially for younger patients with suspected lymph node involvement. However, the limited sample size necessitates larger, randomized trials to confirm these findings and potentially establish D3 lymphadenectomy as standard care.
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Neoplasias del Colon , Estudios de Factibilidad , Escisión del Ganglio Linfático , Humanos , Escisión del Ganglio Linfático/métodos , Neoplasias del Colon/cirugía , Neoplasias del Colon/patología , Masculino , Femenino , Estudios Retrospectivos , Anciano , Londres , Persona de Mediana Edad , Resultado del Tratamiento , Hospitales Generales , Hospitales de Distrito , Supervivencia sin Enfermedad , Estadificación de Neoplasias , Anciano de 80 o más AñosRESUMEN
BACKGROUND AND OBJECTIVES: The efficacy and safety of video-assisted thoracoscopic surgery (VATS) versus open thoracotomy in the treatment of non-small cell lung cancer (NSCLC) were evaluated with a focus on mediastinal lymph node dissection, postoperative recovery, and longterm outcomes including survival rates and disease-free intervals. Materials and Methods: This retrospective study analyzed data from 228 NSCLC patients treated at the Institute of Oncology Bucharest from 2016 to 2022. Both VATS and open surgical approaches were compared, with variables including demographic data, comorbidities, surgical outcomes, and postoperative complications meticulously recorded. Statistical significance was assessed using chi-square and independent samples t-tests. Results: Among the findings, VATS demonstrated significantly better two-year progression-free survival rates for patients in early stages (Stages 1-3) of NSCLC compared to open surgery, with p-values 0.01 and 0.001, respectively. In contrast, no significant difference was observed in Stage 4. Furthermore, VATS resulted in shorter operative times (mean 299 vs. 347 minutes, p 0.001), less estimated blood loss (98.68 mL vs. 160.88 mL, p 0.001), reduced chest tube duration (5.78 days vs. 12.17 days, p 0.001), and decreased hospital stays (12.0 days vs. 27.7 days, p 0.001). Conclusions: VATS is associated with improved long-term disease-free survival for early-stage NSCLC and more favorable short-term surgical outcomes, highlighting its advantages over open thoracotomy. Despite its benefits, VATS did not significantly reduce postoperative complications compared to open surgery.
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Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Escisión del Ganglio Linfático , Estadificación de Neoplasias , Tempo Operativo , Neumonectomía , Cirugía Torácica Asistida por Video , Toracotomía , Humanos , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/patología , Cirugía Torácica Asistida por Video/métodos , Estudios Retrospectivos , Masculino , Neoplasias Pulmonares/cirugía , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Femenino , Persona de Mediana Edad , Toracotomía/métodos , Anciano , Resultado del Tratamiento , Neumonectomía/métodos , Neumonectomía/mortalidad , Escisión del Ganglio Linfático/métodos , Tasa de Supervivencia , Adulto , Rumanía/epidemiología , Supervivencia sin Enfermedad , Tiempo de Internación/estadística & datos numéricosRESUMEN
Breast cancer is rising among women in India. Most of the cases are presented at the locally advanced stage where axillary dissection is needed. In this article, we have described our approach of axillary dissection in the technically challenging high nodal burden axillas.
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Axila , Neoplasias de la Mama , Escisión del Ganglio Linfático , Músculos Superficiales de la Espalda , Humanos , Escisión del Ganglio Linfático/métodos , Femenino , Neoplasias de la Mama/cirugía , Resultado del Tratamiento , India , Colgajos QuirúrgicosAsunto(s)
Prostatectomía , Neoplasias de la Próstata , Biopsia del Ganglio Linfático Centinela , Humanos , Prostatectomía/métodos , Masculino , Neoplasias de la Próstata/cirugía , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/mortalidad , Escisión del Ganglio Linfático/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: One of the approaches to distal sigmoid colon cancer surgical treatment is segmental colonic resection with vascular preservation of left colic artery (LCA). D3 lymph node dissection may technically vary according to different vascular anatomy. This study aims to show the approaches to D3 lymph node dissection with LCA preservation for distal sigmoid colon cancer according to different patterns of inferior mesenteric artery (IMA) branching. METHODS: CT angiography with 3D reconstruction was routinely performed to identify the IMA branching pattern. Laparoscopic distal sigmoid colon resection with D3 lymph node dissection and left colic artery preservation in standardized fashion was performed in all cases. Data, including clinical, intraoperative, and short-term surgical outcomes, is presented as median numbers (Me) and interquartile range (IQR). RESULTS: Twenty-six patients with distal sigmoid colon cancer were treated with laparoscopic distal sigmoid colon resection. The approach to D3 lymph node dissection varied according to different anatomical variations. There was one conversion (3.8%) and one anastomotic leakage (3.8%) in patients with high BMI. At the same time, there was a high apical lymph node count (Me 3 (IQR 2-5), min-max 0-10) due to the skeletonization of the IMA. CONCLUSIONS: The technical aspects of D3 lymph node dissection with left colic artery preservation may vary in different types of LCA and sigmoid artery branching patterns regardless of the standardized anatomical landmarks. The anatomical features should be considered when performing vascular-sparing lymph node dissection.
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Colon Sigmoide , Laparoscopía , Escisión del Ganglio Linfático , Arteria Mesentérica Inferior , Neoplasias del Colon Sigmoide , Humanos , Escisión del Ganglio Linfático/métodos , Neoplasias del Colon Sigmoide/cirugía , Arteria Mesentérica Inferior/cirugía , Arteria Mesentérica Inferior/diagnóstico por imagen , Femenino , Masculino , Anciano , Laparoscopía/métodos , Persona de Mediana Edad , Colon Sigmoide/cirugía , Colon Sigmoide/irrigación sanguínea , Colectomía/métodos , Angiografía por Tomografía Computarizada , Tratamientos Conservadores del Órgano/métodos , Imagenología Tridimensional , Fuga Anastomótica/etiología , Fuga Anastomótica/prevención & control , Resultado del Tratamiento , Colon/irrigación sanguínea , Colon/cirugíaRESUMEN
BACKGROUND: The purpose of this retrospective study was to compare the safety and feasibility of single-intercostal totally minimally invasive Ivor Lewis esophagectomy (MIIE) with those of multiple-intercostal MIIE. METHODS: Between January 2016 and December 2022, clinical data were collected for 528 patients who successfully underwent totally minimally invasive esophagectomy. Among these patients, 294 underwent MIIE, with 200 undergoing the single-intercostal approach and 94 undergoing the multiple-intercostal approach. Propensity score matching (PSM) was applied to the cohort of 294 patients. Subsequently, perioperative outcomes and other pertinent clinical data were analyzed retrospectively. RESULTS: A total of 294 patients were subjected to PSM, and 89 groups of patient data (178 persons in total) were well balanced and included in the follow-up statistics. Compared to the multiple intercostal group, the single intercostal group had a shorter operative time (280 min vs. 310 min; p < 0.05). Moreover, there was no significant difference in the incidence of major perioperative complications (p > 0.05). The total number of lymph nodes sampled (25.30 vs. 27.55, p > 0.05) and recurrent laryngeal nerve lymph nodes sampled on the both sides (p > 0.05) did not significantly differ. The single intercostal group had lower postoperative long-term usage of morphine (0,0-60 vs. 20,20-130; p < 0.01), total temporary addition (10,0-30 vs. 20,20-40; p < 0.01) and temporary usage in the first 3 days after surgery (0,0-15 vs. 10,10-20; p < 0.01) than did the multicostal group.There were no significant differences in age, sex, tumor location or extent of lymphadenectomy or in the clinical factors between the single-intercostal group (p > 0.05). CONCLUSIONS: Both techniques can be used for the treatment of esophageal cancer. Compared to multiple intercostal MIIE, the feasibility of which has been proven internationally, the single intercostal technique can also be applied to patients of different age groups and sexes and with different tumor locations. It can provide surgeons with an additional surgical option. TRIAL REGISTRATION: This study was retrospectively registered by the Ethics Committee of the Second Affiliated Hospital of Zhejiang University School of Medicine, and written informed consent was exempted from ethical review. The registration number was 20,230,326. The date of registration was 2023.03.26.
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Neoplasias Esofágicas , Esofagectomía , Humanos , Masculino , Femenino , Estudios Retrospectivos , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/patología , Esofagectomía/métodos , Esofagectomía/efectos adversos , Persona de Mediana Edad , Anciano , Toracoscopía/métodos , Toracoscopía/efectos adversos , Tempo Operativo , Estudios de Factibilidad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Puntaje de Propensión , Escisión del Ganglio Linfático/métodos , Resultado del Tratamiento , AdultoRESUMEN
Accurate lymph node (LN) retrieval during colorectal carcinoma resection is pivotal for precise N-staging and the determination of adjuvant therapy. Current guidelines recommend the examination of at least 12 mesocolic or mesorectal lymph nodes for accurate staging. Traditional histological processing techniques, reliant on visual inspection and palpation, are time-consuming and heavily dependent on the examiner's expertise and availability. Various methods have been documented to enhance LN retrieval from colorectal specimens, including intra-arterial ex vivo methylene blue injection. Recent studies have explored the utility of indocyanine green (ICG) fluorescence imaging for visualizing pericolic lymph nodes and identifying sentinel lymph nodes in colorectal malignancies. This study included 10 patients who underwent colon resection for malignant tumors. During surgery, intravenous ICG dye and an endoscopic camera were employed to assess intestinal perfusion. Post-resection, ex vivo intra-arterial administration of ICG dye was performed on the specimens, followed by routine histological processing and an ICG-assisted lymph node dissection. The objective was to evaluate whether ICG imaging could identify additional lymph nodes compared to routine manual dissection and to assess the clinical relevance of these findings. For each patient, a minimum of 12 lymph nodes (median = 25.5, interquartile range = 12.25, maximum = 33) were examined. ICG imaging facilitated the detection of a median of three additional lymph nodes not identified during routine processing. Metastatic lymph nodes were found in four patients however no additional metastatic nodes were detected with ICG assistance. Our findings suggest that ex vivo intra-arterial administration of indocyanine green dye can augment lymph node dissection, particularly in cases where the number of lymph nodes retrieved is below the recommended threshold of 12.
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Neoplasias Colorrectales , Estudios de Factibilidad , Verde de Indocianina , Escisión del Ganglio Linfático , Ganglios Linfáticos , Humanos , Verde de Indocianina/administración & dosificación , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/diagnóstico por imagen , Neoplasias Colorrectales/cirugía , Proyectos Piloto , Femenino , Masculino , Anciano , Ganglios Linfáticos/patología , Ganglios Linfáticos/diagnóstico por imagen , Persona de Mediana Edad , Escisión del Ganglio Linfático/métodos , Metástasis Linfática/patología , Metástasis Linfática/diagnóstico por imagen , Colorantes , Fluorescencia , Imagen Óptica/métodos , Anciano de 80 o más Años , Colorantes Fluorescentes/administración & dosificaciónRESUMEN
AIM: To evaluate the role of early prophylactic inguinal node dissection in patients with squamous cell cancer and melanoma of lower limb. MATERIALS AND METHODS: From 2008 to 2018, a Tertiary Care Hospital connected to a teaching institute served as the site of this retrospective observational study. Patient records were gathered with the purpose of gathering clinical, investigative, surgical, pathological and follow-up information. RESULTS: We included 33 patients in this analysis out of the 47 patients we treated ourselves between 2008 and 2018; among these 33 patients, 21 (63.63%) had palpable inguinal nodes at the time of primary presentation. All 21 patients' FNAC tests were positive for metastases, in 16 patients (76.19%). 5 patients on FNAC (23.80%) exhibited not metastases. The remaining 12 patients did not have enlarged lymph nodes at the time of their initial presentation. Patients who did not have palpable lymph node were given the option of having a modified inguinal block dissection. 8 patients with metastatic disease have nodes that are positive in histology. In addition, out of 5 patients with negative nodes 4 (80%) showed evidence of metastasis. CONCLUSION: The conclusion of this retrospective observational study is that although palpable lymph nodes in groin are unquestionably a sign that inguinal nodes should be dissected, prophylactic lymph node dissection should be still done even if nodes are not palpable or provide a negative FNAC result. Given that delayed lymphadenectomy has a significant effect on survival, delaying inguinal lymphadenectomy in non-palpable nodes could cause you to lose the battle against cancer in your lower limb. The related surgical morbidity is the only downside to prophylactic lymph node dissection. This can, however, be effectively decreased with a modified inguinal lymphadenectomy operation.
Résumé Objectif:Évaluer le rôle de la dissection prophylactique précoce du ganglion inguinal chez les patients atteints d'un cancer épidermoïde et d'un mélanome du membre inférieur.Matériels et méthodes:De 2008 à 2018, un hôpital de soins tertiaires relié à un institut d'enseignement a servi de site à cette étude observationnelle rétrospective. Les dossiers des patients ont été rassemblés dans le but de recueillir des informations cliniques, d'investigation, chirurgicales, pathologiques et de suivi.Résultats:Nous avons inclus 33 patients dans cette analyse sur les 47 patients que nous avons nous-mêmes traités entre 2008 et 2018; parmi ces 33 patients, 21 (63,63 %) avaient des ganglions inguinaux palpables au moment de la présentation primaire. Les tests FNAC des 21 patients étaient positifs pour les métastases, chez 16 patients (76,19 %). 5 patients sous FNAC (23,80%) ne présentaient pas de métastases. Les 12 patients restants ne présentaient pas d'hypertrophie des ganglions lymphatiques au moment de leur présentation initiale. Les patients qui n'avaient pas de ganglion lymphatique palpable ont eu la possibilité de subir une dissection par bloc inguinal modifié. 8 patients atteints d'une maladie métastatique ont des ganglions positifs en histologie. De plus, sur 5 patients présentant des ganglions négatifs, 4 (80 %) présentaient des signes de métastases.Conclusion:La conclusion de cette étude observationnelle rétrospective est que même si les ganglions lymphatiques palpables dans l'aine sont incontestablement un signe que les ganglions inguinaux doivent être disséqués, un curage prophylactique des ganglions lymphatiques doit toujours être effectué même si les ganglions ne sont pas palpables ou fournissent un résultat FNAC négatif. Étant donné que le retardement du curage lymphatique a un effet significatif sur la survie, retarder le curage inguinal des ganglions non palpables pourrait vous faire perdre la bataille contre le cancer du membre inférieur. La morbidité chirurgicale associée est le seul inconvénient du curage prophylactique des ganglions lymphatiques. Ceci peut cependant être efficacement réduit grâce à une opération de lymphadénectomie inguinale modifiée.
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Carcinoma de Células Escamosas , Conducto Inguinal , Extremidad Inferior , Escisión del Ganglio Linfático , Ganglios Linfáticos , Metástasis Linfática , Melanoma , Humanos , Escisión del Ganglio Linfático/métodos , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Melanoma/cirugía , Melanoma/patología , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Adulto , Carcinoma de Células Escamosas/cirugía , Carcinoma de Células Escamosas/patología , Anciano , Extremidad Inferior/cirugía , Conducto Inguinal/cirugía , Neoplasias Cutáneas/cirugía , Neoplasias Cutáneas/patología , Resultado del Tratamiento , Ingle/cirugíaAsunto(s)
Anastomosis Quirúrgica , Neoplasias del Colon , Laparoscopía , Escisión del Ganglio Linfático , Procedimientos Quirúrgicos Robotizados , Humanos , Escisión del Ganglio Linfático/métodos , Neoplasias del Colon/cirugía , Neoplasias del Colon/patología , Procedimientos Quirúrgicos Robotizados/métodos , Anastomosis Quirúrgica/métodos , Laparoscopía/métodos , Colon Descendente/cirugía , Colectomía/métodos , Masculino , Anciano , Femenino , Persona de Mediana EdadRESUMEN
The aim of this meta-analysis was to compare the efficacy of robot distal gastrectomy (RDG) versus laparoscopic distal gastrectomy (LDG) for gastric cancer. Studies included only those that utilized propensity score matching (PSM). A systematic literature search was conducted in several major global databases, including PubMed, Embase, and Google Scholar, up to June 2024. Articles were screened based on predefined inclusion and exclusion criteria. Baseline data and primary and secondary outcome measures (e.g., operative time, estimated blood loss, lymph-node yield dissection, length of hospital stay, and time to first flatus) were extracted. The quality of PSM studies was assessed using the ROBINS-I, and data were analyzed using Review Manager 5.4.1 software. A total of 12 propensity score-matched studies involving 3688 patients were included in this meta-analysis. Robot-assisted surgery resulted in a longer operative time (WMD 30.64 min, 95% CI 15.63 - 45.66; p < 0.0001), less estimated blood loss (WMD 29.54 mL, 95% CI - 47.14 - 11.94; p = 0.001), more lymph-node yield (WMD 5.14, 95% CI 2.39 - 7.88; p = 0.0002), and a shorter hospital stay (WMD - 0.36, 95% CI - 0.60 - 0.12; p = 0.004) compared with laparoscopic surgery. There were no significant differences between the two surgical methods in terms of time to first flatus, overall complications, and major complications. Robot distal gastrectomy for gastric cancer reduces intraoperative blood loss, increases lymph-node yield, and shortens hospital stay compared with laparoscopic surgery, despite a longer operative time. There are no significant differences in time to first flatus and complication rates between the two groups.
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Gastrectomía , Laparoscopía , Tiempo de Internación , Tempo Operativo , Puntaje de Propensión , Procedimientos Quirúrgicos Robotizados , Neoplasias Gástricas , Neoplasias Gástricas/cirugía , Gastrectomía/métodos , Humanos , Laparoscopía/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Tiempo de Internación/estadística & datos numéricos , Resultado del Tratamiento , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Escisión del Ganglio Linfático/métodosRESUMEN
Gallbladder cancer (GBC) is a rare disease with a poor prognosis. Simple cholecystectomy may be an adequate treatment only for very early disease (Tis, T1a), whereas reoperation is recommended for more advanced disease (T1b and T2). Radical cholecystectomy should have two fundamental objectives: To radically resect the liver parenchyma and to achieve adequate clearance of the lymph nodes. However, recent studies have shown that compared with lymph node dissection alone, liver resection does not improve survival outcomes. The oncological roles of lymphadenectomy and liver resection is distinct. Therefore, for patients with incidental GBC without liver invasion, hepatic resection is not always mandatory.
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Colecistectomía , Neoplasias de la Vesícula Biliar , Hepatectomía , Escisión del Ganglio Linfático , Humanos , Colecistectomía/efectos adversos , Colecistectomía/métodos , Neoplasias de la Vesícula Biliar/cirugía , Neoplasias de la Vesícula Biliar/patología , Hepatectomía/métodos , Hepatectomía/efectos adversos , Hallazgos Incidentales , Hígado/cirugía , Hígado/patología , Hígado/diagnóstico por imagen , Escisión del Ganglio Linfático/métodos , Escisión del Ganglio Linfático/efectos adversos , Metástasis Linfática , Estadificación de Neoplasias , Peritoneo/cirugía , Peritoneo/patología , Resultado del TratamientoAsunto(s)
Neoplasias de la Vesícula Biliar , Escisión del Ganglio Linfático , Procedimientos Quirúrgicos Robotizados , Humanos , Neoplasias de la Vesícula Biliar/cirugía , Neoplasias de la Vesícula Biliar/mortalidad , Neoplasias de la Vesícula Biliar/patología , Procedimientos Quirúrgicos Robotizados/métodos , Escisión del Ganglio Linfático/métodos , Colecistectomía/métodos , Resultado del TratamientoRESUMEN
We present the trial-and-error process of standardizing robot-assisted radical nephroureterectomy (RANU) at a high-volume center in Japan. Our urology team performed 53 RANU cases using the Da Vinci Xi system, undergoing five major evolutionary stages. We performed RANU via transperitoneal approach in all cases and lymph-node dissection in selected cases. During the evolution, we adopted a lithotomy position and significantly modified port placement to facilitate lower ureter management. However, we ultimately arrived at a method that minimizes port and patient repositioning during lower ureter processing. By strategically placing ProGrasp™ forceps in the most caudal port, we effectively retracted the bladder and grasped the opened bladder wall during lower ureter manipulation. This approach also allowed us to perform pelvic, para-aortic, and renal portal lymph-node dissection without major changes in patient positioning or port placement. Nevertheless, we acknowledge that some variations in positioning and techniques may be necessary depending on specific case requirements.
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Escisión del Ganglio Linfático , Nefroureterectomía , Procedimientos Quirúrgicos Robotizados , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Hospitales de Alto Volumen , Japón , Escisión del Ganglio Linfático/métodos , Nefroureterectomía/métodos , Posicionamiento del Paciente/métodos , Peritoneo/cirugía , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/normas , Uréter/cirugíaRESUMEN
Treatment de-escalation strategies in patients with seminoma with retroperitoneal metastases are being investigated in ongoing clinical trials. Primary retroperitoneal lymph node dissection conducted by expert surgeons may avoid any cytotoxic treatment and related long-term side effects in ≥70% of patients with clinical stage IIA/B seminoma.
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Escisión del Ganglio Linfático , Estadificación de Neoplasias , Seminoma , Neoplasias Testiculares , Humanos , Escisión del Ganglio Linfático/métodos , Masculino , Neoplasias Testiculares/patología , Neoplasias Testiculares/cirugía , Seminoma/cirugía , Seminoma/patología , Espacio Retroperitoneal , Neoplasias Retroperitoneales/cirugía , Neoplasias Retroperitoneales/patología , Neoplasias Retroperitoneales/secundario , Metástasis Linfática , Neoplasias de Células Germinales y Embrionarias/cirugía , Neoplasias de Células Germinales y Embrionarias/patología , Neoplasias de Células Germinales y Embrionarias/secundarioRESUMEN
BACKGROUND: Hepatic alveolar echinococcosis (AE) is a severe zoonotic parasitic disease, and accurate preoperative prediction of lymph node (LN) metastasis in AE patients is crucial for disease management, but it remains an unresolved challenge. The aim of this study was to establish a radiomics model for the preoperative prediction of LN metastasis in hepatic AE patients. METHODS: A total of 100 hepatic AE patients who underwent hepatectomy and hepatoduodenal ligament LN dissection at Qinghai Provincial People's Hospital between January 2016 and August 2023 were included in the study. The patients were randomly divided into a training set and a validation set at an 8:2 ratio. Radiomic features were extracted from three-dimensional images of the hepatoduodenal ligament LNs delineated on arterial phase computed tomography (CT) scans of hepatic AE patients. Least absolute shrinkage and selection operator (LASSO) regression was applied for data dimensionality reduction and feature selection. Multivariate logistic regression analysis was performed to develop a prediction model, and the predictive performance of the model was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). RESULTS: A total of 7 radiomics features associated with LN status were selected using LASSO regression. The classification performances of the training set and validation set were consistent, with area under the operating characteristic curve (AUC) values of 0.928 and 0.890, respectively. The model also demonstrated good stability in subsequent validation. CONCLUSION: In this study, we established and evaluated a radiomics-based prediction model for LN metastasis in patients with hepatic AE using CT imaging. Our findings may provide a valuable reference for clinicians to determine the occurrence of LN metastasis in hepatic AE patients preoperatively, and help guide the implementation of individualized surgical plans to improve patient prognosis.
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Equinococosis Hepática , Escisión del Ganglio Linfático , Ganglios Linfáticos , Tomografía Computarizada por Rayos X , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Equinococosis Hepática/cirugía , Equinococosis Hepática/diagnóstico por imagen , Equinococosis Hepática/patología , Hepatectomía/métodos , Escisión del Ganglio Linfático/métodos , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/parasitología , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Radiómica , Estudios Retrospectivos , Curva ROC , Tomografía Computarizada por Rayos X/métodosRESUMEN
INTRODUCTION: Total resection of the gastric tube with lymphadenectomy for advanced gastric tube cancer is highly invasive and associated with severe complications. Other surgical option, partial gastrectomy or wedge resection, is insufficient if lymph node metastasis is suspected. Therefore, a technique balancing invasiveness and curability is required. MATERIALS AND SURGICAL TECHNIQUE: First, we laparoscopically peeled off adhesions of the gastric tube, gastric mesentery (including the right gastroepiploic artery/vein), pericardial membrane, and aorta, up to the planned resection line. Subsequently, we cut the infrapyloric and right gastric arteries at their roots and dissected No. 5 and No. 6 lymph nodes. We taped and spared the right gastroepiploic artery and vein and dissected the tissues including No. 4d lymph nodes. Finally, the gastric tube was cut using a linear stapler, and the remaining gastric tube was anastomosed to the jejunum with a circular stapler. The mean operative time for the three cases treated using this intervention was 729 min. The patients were discharged on postoperative day 8 or 9 without any complications. They all remained alive and recurrence-free. DISCUSSION: This novel approach balances invasiveness and curability by leveraging the advantages of laparoscopy. The procedure was performed safely and reproducibly in three consecutive cases, providing another viable option for the treatment of gastric tube cancer.
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Esofagectomía , Gastrectomía , Arteria Gastroepiploica , Laparoscopía , Escisión del Ganglio Linfático , Neoplasias Gástricas , Humanos , Laparoscopía/métodos , Escisión del Ganglio Linfático/métodos , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/patología , Gastrectomía/métodos , Masculino , Esofagectomía/métodos , Persona de Mediana Edad , Anciano , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/patología , FemeninoRESUMEN
PURPOSE: This research aimed to clarify the metastatic patterns of subcarinal, right and left recurrent laryngeal nerve lymph nodes in thoracic esophageal squamous cell carcinoma and to investigate appropriate strategies for lymph node dissection. METHODS: Patients with thoracic esophageal squamous cell carcinoma receiving esophagectomy from December 2020 to April 2024 were retrospectively analyzed. Risk factors for subcarinal, right and left recurrent laryngeal nerve lymph nodes metastasis were determined by chi-square test and multivariate logistic regression analysis. We visualized the metastasis rates of these specific lymph nodes based on the different clinicopathological characteristics. Correlation between subcarinal, right and left recurrent laryngeal lymph nodes metastasis and postoperative complications were also analyzed. RESULTS: A total of 503 thoracic esophageal squamous carcinoma patients who underwent esophagectomy were enrolled. The metastasis rates of subcarinal, right and left recurrent laryngeal nerve lymph nodes were 10.3%, 10.3%, and 10.9%, respectively. The lymphovascular invasion status and tumor location were the significant predictors for subcarinal and right recurrent laryngeal nerve lymph nodes metastasis, respectively (P < 0.001 and P = 0.013). For left recurrent laryngeal nerve lymph node metastasis, younger age (P = 0.020) and presence of lymphovascular invasion (P = 0.009) were significant risk factors. Additionally, pulmonary infection is the most frequent postoperative complication in patients with dissection of subcarinal, right and left recurrent laryngeal lymph nodes. There was no significant difference in the incidence of anastomotic leakage (P = 0.872), pulmonary infection (P = 0.139), chylothorax (P = 0.702), and hoarseness (P = 0.179) between the subcarinal lymph node dissection cohort and the reservation cohort. The incidence of hoarseness significantly increased in both right (P = 0.042) and left (P = 0.010) recurrent laryngeal nerve lymph nodes dissection cohorts compared by the reservation cohorts, with incidence rates of 5.9% and 6.7%, respectively. CONCLUSIONS: The metastasis rates of subcarinal, right and left recurrent laryngeal nerve lymph nodes in thoracic esophageal squamous cell carcinoma were all over 10%. The dissection of subcarinal lymph nodes does not increase postoperative complications risk, while recurrent laryngeal nerve lymph nodes dissection significantly increases the incidence of hoarseness. Thus, lymph node dissection of subcarinal lymph nodes should be conducted routinely, while recurrent laryngeal nerve lymph nodes dissection may be selectively performed in specific patients.
Asunto(s)
Neoplasias Esofágicas , Carcinoma de Células Escamosas de Esófago , Esofagectomía , Escisión del Ganglio Linfático , Ganglios Linfáticos , Metástasis Linfática , Nervio Laríngeo Recurrente , Humanos , Masculino , Femenino , Persona de Mediana Edad , Nervio Laríngeo Recurrente/patología , Estudios Retrospectivos , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/cirugía , Carcinoma de Células Escamosas de Esófago/cirugía , Carcinoma de Células Escamosas de Esófago/patología , Carcinoma de Células Escamosas de Esófago/secundario , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Esofagectomía/efectos adversos , Esofagectomía/métodos , Anciano , Escisión del Ganglio Linfático/efectos adversos , Escisión del Ganglio Linfático/métodos , Terapia Neoadyuvante , Adulto , Factores de Riesgo , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiologíaRESUMEN
OBJECTIVE: To compare the short-term results of complete mesogastric excision with the conventional surgical technique. STUDY DESIGN: An experimental study. Place and Duration of the Study: Department of Gastroenterological Surgery, Health Sciences University, Basaksehir City Hospital, Istanbul, Turkiye, from April to December 2023. METHODOLOGY: Comparison of short-term results of open total gastrectomy + mesogastrectomy with standard total gastrectomy + D2 lymph node dissection at a tertiary centre in terms of peroperative results, histopathological findings, and postoperative short-term outcomes prospectively, with review of the literature. RESULTS: A total of 37 patients were included in the study. The groups involved 26 male and 11 female patients. The study group included 14 patients while the control group involved 23 patients. The mean blood loss (mL) was significantly lower and number of metastatic lymph nodes was significantly higher in the study group. CONCLUSION: Total mesogastric excision is a safe technique which has advantages over conventional D2 gastrectomy in terms of not only peroperative and short-term outcomes, but also disease-free survival. This is the first study from a different population of the world and initial results can contribute to the literature for universalisation. KEY WORDS: Complete mesogastrium excision, D2 lymphadenectomy, Gastric cancer, Gastrectomy, Mesogastrectomy.
Asunto(s)
Gastrectomía , Escisión del Ganglio Linfático , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/patología , Masculino , Escisión del Ganglio Linfático/métodos , Femenino , Gastrectomía/métodos , Persona de Mediana Edad , Anciano , Adulto , Resultado del Tratamiento , Metástasis Linfática , Estudios Prospectivos , Supervivencia sin Enfermedad , TurquíaAsunto(s)
Escisión del Ganglio Linfático , Neoplasias de la Vulva , Humanos , Neoplasias de la Vulva/radioterapia , Neoplasias de la Vulva/patología , Neoplasias de la Vulva/cirugía , Femenino , Escisión del Ganglio Linfático/métodos , Metástasis Linfática , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Ganglios Linfáticos/efectos de la radiaciónRESUMEN
PURPOSE: The higher detection efficacy of PSMA PET for oligometastatic recurrence of prostate cancer has promoted new loco-regional treatment options. PSMA-targeted radioguided surgery (PSMA-RGS) was introduced to facilitate salvage surgery of small tumor deposits. The objectives of this retrospective analysis are to describe an independent single-center consecutive cohort of patients undergoing PSMA-RGS and to evaluate its clinical and oncological outcomes. METHOD: Between 2018 and 2022, 53 patients were treated with PSMA-RGS and 50 patients were available for final analyses. All patients were initially treated with radical prostatectomy (RP) and presented with biochemical recurrence (BCR) with at least one positive lesion on PSMA-PET imaging. After preparation of 99mTc-PSMA-I&S and intravenous injection, surgery was performed by using a gamma-probe intraoperatively. RESULTS: Median age was 70 years (IQR 65-73) and the median PSA at salvage surgery was 1.2 ng/mL (IQR 0.6-3.0). In all patients pathologically positive lesions could be removed during PSMA-RGS. 29 (58%) patients had one pathologically positive lesion, 14 (28%) had two and 7 (14%) had three or more, respectively. The overall complication rate was 26% with 4 (8%), 1 (2%), and 8 (16%) having Clavien-Dindo (CD) type I, II, and IIIb complications, respectively. During the follow-up period 31 (62%) patients experienced BCR and 29 (58%) received further therapy. CONCLUSIONS: PSMA-RGS is a promising treatment option to enhance salvage surgery in early biochemical recurrence. However, only 42% of the patients treated with PSMA RGS remain without a biochemical recurrence. Further research is mandatory to identify patients, who profit from PSMA-RGS.