RESUMO
PURPOSE: Open inguinal lymph node dissection (OILND) plays a crucial role in penile cancer management, but in order to improve patient outcomes, minimally-invasive (MILND) approaches were developed. Our "bottoms-up" MILND is a novel endoscopic technique, changing the way the sequence of dissection is performed. This study aims to compare our approach to the current standard of OILND in terms of oncologic and perioperative outcomes. MATERIALS AND METHODS: In our database, from 2016 to 2023, 12 patients underwent OILND and 16 had a "bottoms-up" MILND, which is performed with a three port configuration, starting the dissection under the fascia lata, dissecting the femoral vessels in the most distal part of the femoral fossa, followed by dissection of the proximal and superficial lymph nodes at the top of thefemoral triangle. RESULTS: For MILND, median operation time per groin was shorter (58 vs 64 minutes, p=0.34), patients presented shorter hospital stays (10 vs 18 days, p=0.32) and fewer days with drains (14 vs 24 days, p=0.01). Median lymph node yield per groin was higher for MILND (10 vs 9 nodes, p=0.7), but OILND had a higher median of positive lymph nodes (4 vs 3 nodes, p=0.63). MILND patients experienced a lower incidence of major complications (33% vs 58%, p=0.007). CONCLUSIONS: We have proved that our technique of MILND is not inferior to the current standard and we believe that it can further improve patient outcomes with a safer, simplified and easily reproducible approach.
Assuntos
Canal Inguinal , Excisão de Linfonodo , Procedimentos Cirúrgicos Minimamente Invasivos , Neoplasias Penianas , Humanos , Masculino , Neoplasias Penianas/cirurgia , Neoplasias Penianas/patologia , Excisão de Linfonodo/métodos , Pessoa de Meia-Idade , Idoso , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Duração da Cirurgia , Tempo de Internação/estatística & dados numéricos , Resultado do Tratamento , Estudos Retrospectivos , Endoscopia/métodosRESUMO
OBJECTIVE: This study sought to explore the efficiency of para-aortic and pelvic lymphadenectomy in the treatment of locally advanced cervical cancer (LACC) with pelvic lymph node (PLN) metastasis. METHODS: A total of 171 LACC patients with imaging-confirmed pelvic lymph node metastasis were included in this study. These patients were divided into two groups: the surgical staging group, comprising 58 patients who had received para-aortic and pelvic lymphadenectomy (surgical staging) along with concurrent chemoradiation therapy (CCRT), and the imaging staging group, comprising 113 patients who had received only CCRT. The two groups' progression-free survival (PFS), overall survival (OS) and treatment-related complications were compared. RESULTS: The surgical staging group started radiotherapy 10.2 days (range 9-12 days) later than the imaging staging group. The overall incidence of lymphatic cysts was 9.30%. In the surgical staging group, para-aortic lymph node metastasis was identified in 34.48% (20/58) of patients, while pathology-negative PLN was observed in 12.07% (7/58). Over a median follow-up period of 52 months, no significant differences in PFS and OS rates were found between the two groups (p > 0.05). Subgroup analysis of patients with lymph node diameters of ≥ 1.5 cm revealed a five-year PFS rate of 75.0% and an OS rate of 80.0% in the surgical staging group, compared to 41.5% and 50.1% in the imaging staging group, respectively, showing statistically significant differences (p = 0.022, HR:0.34 [0.13, 0.90] and p = 0.038, HR: 0.34 [0.12,0.94], respectively for PFS and OS). Additionally, in patients with two or more metastatic lymph nodes, the five-year PFS and OS rates were 69.2% and 73.1% in the surgical staging group, versus 41.0% and 48.4% in the imaging staging group, with these differences also being statistically significant (p = 0.025, HR: 0.41[0.19,0.93] and p = 0.046, HR: 0.42[0.18,0.98], respectively). CONCLUSION: Performing surgical staging before CCRT is safe and delivers accurate lymph node details crucial for tailoring radiotherapy. This approach merits further investigation, particularly in women with pelvic lymph nodes measuring 1.5 cm or more in diameter or patients with two or more imaging-positive PLNs.
Assuntos
Excisão de Linfonodo , Linfonodos , Metástase Linfática , Pelve , Neoplasias do Colo do Útero , Humanos , Feminino , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/terapia , Neoplasias do Colo do Útero/mortalidade , Excisão de Linfonodo/métodos , Pessoa de Meia-Idade , Adulto , Seguimentos , Taxa de Sobrevida , Linfonodos/patologia , Linfonodos/cirurgia , Pelve/patologia , Pelve/cirurgia , Prognóstico , Idoso , Estudos Retrospectivos , Quimiorradioterapia/métodos , Estadiamento de Neoplasias , Aorta/patologia , Aorta/cirurgia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/terapia , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/secundárioRESUMO
BACKGROUND: This study aimed to explore the clinical value of 3D video-assisted thoracoscopic surgery in dissecting recurrent laryngeal nerve lymph nodes in patients undergoing minimally invasive esophagectomy. METHODS: A retrospective cohort study was conducted on 205 patients, including 120 males, who underwent esophagectomy from May 2018 to May 2020 in the Department of Thoracic Surgery at the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University. Perioperative parameters, including intraoperative blood loss, operation time, the number of dissected recurrent laryngeal nerve lymph nodes, the incidence and degree of postoperative recurrent laryngeal nerve injury, the volume of postoperative thoracic drainage, and postoperative complications, were compared between the 3D and 2D groups. RESULTS: There were no significant differences in the preoperative baseline data between these two groups (P > 0.05). The number of dissected recurrent laryngeal nerve lymph nodes in the 3D group was significantly higher than in the 2D group (P < 0.05). The operation times were significantly shorter in the 3D group than in the 2D group (P < 0.05). The volume of thoracic drainage in the first 2 days was significantly less in the 3D group than in the 2D group (P < 0.05). CONCLUSIONS: Compared to the 2D system, the application of 3D video-assisted thoracoscopic surgery in minimally invasive esophagectomy can increase the number of dissected recurrent laryngeal nerve lymph nodes and ensure safety. Additionally, it can reduce the duration of the operation, decrease early postoperative thoracic drainage volume, and promote patient recovery.
Assuntos
Esofagectomia , Excisão de Linfonodo , Nervo Laríngeo Recorrente , Cirurgia Torácica Vídeoassistida , Humanos , Esofagectomia/métodos , Estudos Retrospectivos , Masculino , Pessoa de Meia-Idade , Feminino , Excisão de Linfonodo/métodos , Cirurgia Torácica Vídeoassistida/métodos , Idoso , Neoplasias Esofágicas/cirurgia , Imageamento Tridimensional , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/etiologia , Duração da Cirurgia , Traumatismos do Nervo Laríngeo Recorrente/prevenção & controle , Traumatismos do Nervo Laríngeo Recorrente/etiologiaAssuntos
Anastomose Cirúrgica , Neoplasias do Colo , Laparoscopia , Excisão de Linfonodo , Procedimentos Cirúrgicos Robóticos , Humanos , Excisão de Linfonodo/métodos , Neoplasias do Colo/cirurgia , Neoplasias do Colo/patologia , Procedimentos Cirúrgicos Robóticos/métodos , Anastomose Cirúrgica/métodos , Laparoscopia/métodos , Colo Descendente/cirurgia , Colectomia/métodos , Masculino , Idoso , Feminino , Pessoa de Meia-IdadeRESUMO
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.
Assuntos
Neoplasias Esofágicas , Esofagectomia , Humanos , Masculino , Feminino , Estudos Retrospectivos , Neoplasias Esofágicas/cirurgia , Neoplasias Esofágicas/patologia , Esofagectomia/métodos , Esofagectomia/efeitos adversos , Pessoa de Meia-Idade , Idoso , Toracoscopia/métodos , Toracoscopia/efeitos adversos , Duração da Cirurgia , Estudos de Viabilidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Pontuação de Propensão , Excisão de Linfonodo/métodos , Resultado do Tratamento , AdultoRESUMO
Because of the increasing popularity of Hugo RAS as a surgical platform, a comparison examination of intraoperative and oncological outcomes across DaVinci and Hugo RAS robotic surgery platforms is urgently needed. We carried out a comprehensive review and meta-analysis of the literature of current research, comprehensively searching PubMed, Cochrane and Embase for eligible studies comparing the results between the DaVinci and Hugo RAS. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria were followed in the conduct of this study, with language restricted to English and a final search date of June 2024. We excluded articles composed solely of conference abstracts and irrelevant content. Composite outcomes were assessed using weighted mean differences (WMD) and odds ratios (ORs). The risk of bias in individual research was assessed using the Newcastle-Ottawa Scale (NOS), and heterogeneity and bias risk were controlled for using a sensitivity analysis. Six studies in all were considered, comprising 1025 patients, including 626 DaVinci patients and 399 Hugo RAS patients. Review Manager V5.4.1 software (Cochrane Collaboration, Oxford, UK) was utilized to conduct the meta-analysis, including 6 trials, which demonstrated that compared to Hugo RAS, DaVinci was associated with statistically significant differences in several outcomes: a reduction in operative time (OT) (WMD - 8.46, 95% CI - 13.56 to 3.36; p = 0.001), an increase in estimated blood loss (EBL) (WMD 41.68, 95% CI 23.59 to 59.77; p < 0.00001), and an increased pelvic lymphadenectomy ratio (OR 1.5, 95% CI 1.05-2.05; p = 0.01). On the contrary, there were no statistically noteworthy differences in the length of hospital stay (LOS) between the two teams (WMD - 0.05, 95% CI - 0.14 to 0.04; p = 0.25), nerve sparing (unilateral or bilateral) (OR 0.96, 95% CI 0.68-1.35; p = 0.8), postoperative complications (OR 1.15, 95% CI 0.50-2.64; p = 0.75), or positive surgical margins (PSM) (OR 1.08, 95% CI 0.76-1.54; p = 0.68). Although DaVinci offers shorter operating times (OT) and increased pelvic lymph node dissection rates, Hugo RAS demonstrates lower estimated blood loss (EBL). Overall, Hugo RAS Robot-Assisted Radical Prostatectomy (RARP) results seem to be similar to those obtained with the DaVinci system. Further research and long-term follow-up are necessary to ascertain durable oncological and functional outcomes, allowing doctors to switch between robotic systems and use their skills. These findings are crucial for patients, surgeons, and healthcare policymakers and warrant future studies with extended follow-up.
Assuntos
Duração da Cirurgia , Prostatectomia , Neoplasias da Próstata , Procedimentos Cirúrgicos Robóticos , Humanos , Procedimentos Cirúrgicos Robóticos/métodos , Prostatectomia/métodos , Masculino , Neoplasias da Próstata/cirurgia , Resultado do Tratamento , Tempo de Internação/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Excisão de Linfonodo/métodosRESUMO
In the past two decades, with the development and application of laparoscopic technique and the promotion of the concept of complete mesocolic excision, significant changes have occurred in the surgical treatment of right-sided colon cancer. The Chinese Society of Colorectal Surgery and Chinese Colorectal Research Consortium (CCRC) Organized national experts in colorectal surgery to form a consensus on 14 key clinical issues related to right hemicolectomy, taking into account the preferences of Chinese doctors and patients as well as the pros and cons of intervention measures, with a view to standardizing the surgical treatment of right colon cancer. The consensus recommendations were focused on three main aspects: (1) surgical anatomy: the key structures and its definitions related to the mesentery and vascular anatomy were clarified. It is recommended that the left side of the superior mesenteric artery be considered the medial boundary for complete mesocolic excision; (2) surgical technique: laparoscopy is recommended as the preferred surgical approach for right-sided colon cancer; (3) surgical principles: D2 lymph node dissection could be considered as the standard of care for right-sided colon cancer. Standard D2 could be considered as routine procedure unless preoperative imaging or intraoperative exploration revealed suspected regional lymph node metastasis. Dissection of infrapyloric lymph node is not recommended unless it is suspected as metastasis. Additionally, consensus recommendations were made regarding the location of vascular ligation, the extent of bowel resection, and anastomosis techniques.
Assuntos
Colectomia , Neoplasias do Colo , Laparoscopia , Excisão de Linfonodo , Humanos , Neoplasias do Colo/cirurgia , Laparoscopia/métodos , Colectomia/métodos , China , Excisão de Linfonodo/métodos , Consenso , Mesocolo/cirurgia , Artéria Mesentérica Superior/cirurgia , Cirurgia Colorretal/métodos , Metástase LinfáticaRESUMO
The incidence of esophagogastric junction adenocarcinoma is increasing gradually. The surgical procedures mainly include radical resection of the primary tumor, lymph node dissection, and digestive tract reconstruction. Due to the special anatomical location of esophagogastric junction adenocarcinoma, the pattern of lymph node metastasis is not clear, and regional lymph nodes dissection especially in the lower mediastinum is still controversial, and awaits further high-quality evidence. Meanwhile, due to the special anatomical location of the lower mediastinum, it is often difficult to perform lower mediastinal lymph node dissection. How to complete the lower mediastinal lymph nodes dissection more safely and effectively is the key point for gastric cancer surgeons. In this paper, the progress, consensus, and controversy on the extent of lower mediastinal lymph nodes dissection in patients with esophagogastric junction adenocarcinoma were discussed. Based on our own experience, the current clinically techniques for lower mediastinal lymph nodes dissection were summarized to further improve the quality control of lower mediastinal lymph nodes dissection in patients with esophagogastric junction adenocarcinoma.
Assuntos
Adenocarcinoma , Neoplasias Esofágicas , Junção Esofagogástrica , Excisão de Linfonodo , Mediastino , Neoplasias Gástricas , Humanos , Excisão de Linfonodo/métodos , Adenocarcinoma/cirurgia , Adenocarcinoma/patologia , Mediastino/cirurgia , Neoplasias Esofágicas/cirurgia , Neoplasias Esofágicas/patologia , Neoplasias Gástricas/cirurgia , Neoplasias Gástricas/patologia , Linfonodos/patologia , Metástase LinfáticaRESUMO
Lymphatic metastasis is one of the main pathways of colorectal cancer spread and also a crucial factor in patient long-term prognosis. Lymph node dissection in the possible tumor drainage area, particularly the central group of lymph nodes at the root of the tumor-associated supplying artery, is a key and challenging aspect of surgical techniques. Currently, the patterns of lymphatic drainage and the distribution of central lymph nodes in left-sided colon cancer are not well illustrated, and there is no consensus on the necessity and extent of central lymph node dissection. This has led to significant variability in the extent of lymph node dissection among different surgeons in clinical practice, a lack of quality control standards for surgical procedures, and impacts on postoperative treatment strategy and long-term outcomes. Moreover, current research on lymphatic drainage and metastasis is primarily based on traditional anatomy, whereas individualized, precise approaches to lymph node dissection have not been realized. The application of preoperative and intraoperative lymph node imaging techniques based on functional anatomy in colorectal cancer patients is still under exploration.
Assuntos
Neoplasias do Colo , Excisão de Linfonodo , Linfonodos , Metástase Linfática , Humanos , Excisão de Linfonodo/métodos , Neoplasias do Colo/cirurgia , Neoplasias do Colo/patologia , Linfonodos/patologiaRESUMO
OBJECTIVE: In endometrial cancer surgery, sentinel lymph node dissection is used instead of staging surgery, particularly in advanced disease that is limited to the uterus. The aim of this study is to evaluate our practice of robotic sentinel lymph node dissection, which is applied to endometrial cancer patients in our tertiary cancer treatment center, according to the current literature, and to share our own data. METHODS: Included in our analysis are patients who underwent robotic sentinel lymph node dissection for endometrial cancer utilizing indocyanine green in our center between January 2018 and January 2024. RESULTS: In all, of the 93 endometrial carcinoma patients who underwent sentinel lymph node biopsy, 63 were classified as low-risk, while 30 were high-risk according to the European Society of Gynaecological Oncology and National Comprehensive Cancer Network guidelines. We found sentinel lymph nodes in both low-risk and high-risk patients, with an overall sensitivity of 96.32% (95% confidence interval [CI], 85.12-99.71), specificity of 100% (95%CI, 92.20-99.8), negative predictive value of 96.72% (95%CI, 87.03-99.89), and negative likelihood ratio of 0.06 (95%CI, 0.01-0.36). CONCLUSION: After evaluating our data retrospectively, we determined that we were compatible with the current literature.
Assuntos
Neoplasias do Endométrio , Procedimentos Cirúrgicos Robóticos , Biópsia de Linfonodo Sentinela , Centros de Atenção Terciária , Humanos , Feminino , Neoplasias do Endométrio/cirurgia , Neoplasias do Endométrio/patologia , Procedimentos Cirúrgicos Robóticos/métodos , Pessoa de Meia-Idade , Biópsia de Linfonodo Sentinela/métodos , Idoso , Estudos Retrospectivos , Adulto , Sensibilidade e Especificidade , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia , Excisão de Linfonodo/métodos , Verde de Indocianina , Estadiamento de Neoplasias , Idoso de 80 Anos ou mais , Metástase LinfáticaRESUMO
BACKGROUND: Colorectal cancer is the 3rd most common cancer worldwide, representing 10% of all cancer types, and is considered the 2nd leading cause of cancer-related deaths. It usually metastasizes to the liver or lung. Para-aortic lymph node metastasis is considered a metastatic disease (stage 4) according to the AJCC and is considered a regional disease (stage 3) according to the JSCCR. Para-aortic lymph node metastases occur in about 1% of cases. Neoadjuvant CTH, followed by PALN, is the best option for metastatic para-aortic LNs in colorectal cancer patients. This study addresses the value of prophylactic para-aortic LN dissection among colon-rectal cancer patients (overtreatment protocol). METHODOLOGY: This is a prospective study that included patients attending NCI, Cairo University, from December 2020 to December 2023 who were complaining of left colonic cancer or recto-sigmoid cancer and underwent left hemicolectomy, sigmoid colectomy, or LAR. All patients underwent formal mesenteric LN dissection and prophylactic para-aortic LN dissection. RESULTS: Among 60 patients who underwent colorectal surgery with prophylactic para-aortic LN dissection, 21 cases (35%) were in the descending colon, 22 cases (36.7%) were in the sigmoid colon, 11 cases (18.3%) were in the recto-sigmoid, and 6 cases (10%) were in the upper rectum. 55 cases (91.7%) were in grade 2, and 5 cases (8.3%) were in grade 3. Neoadjuvant CTH was given in 3 cases (5%) while neoadjuvant RTH was given in 6 cases (10%). Regarding reported postoperative complications, lymphorrhea was reported in 2 patients (3.3%) and wound infection occurred in 6 patients (10%). A recurrence was reported among 8 cases (13.4%). CONCLUSIONS: We aimed in this study to highlight the value of prophylactic para-aortic lymph node dissection among colorectal cancer patients (over-treatment protocol) and report its reflection on predicting the behavior of the disease and subsequently selecting the patients who will be suitable to do this procedure.
Assuntos
Neoplasias Colorretais , Excisão de Linfonodo , Humanos , Masculino , Feminino , Excisão de Linfonodo/métodos , Estudos Prospectivos , Projetos Piloto , Pessoa de Meia-Idade , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Metástase Linfática , Idoso , Prognóstico , Seguimentos , Adulto , Colectomia/métodos , Linfonodos/patologia , Linfonodos/cirurgia , Terapia Neoadjuvante/métodosRESUMO
BACKGROUND: Axillary lymph node dissection (ALND) is the standard axillary management for breast cancer patients with positive sentinel lymph node biopsy (SLNB) after neoadjuvant therapy. Nevertheless, when that happens, the frequency of additional positive nodes is not properly evaluated. We aim to develop a prediction model to assess the frequency of additional nodal disease after a positive sentinel lymph node following neoadjuvant therapy. METHODS: We retrospectively analyzed the ultrasound and clinicopathological characteristics of breast cancer patients with 1-3 positive sentinel lymph nodes (SLN) undergoing mastectomy after neoadjuvant therapy (NAT) at our institution, and performed univariate and multivariate logistic analyses to confirm the factors affecting non-SLN metastasis. These factors were included to establish a nomogram, and the area under receiver operating characteristic curve (AUC) and decision curve analysis (DCA) were utilized to assess the validity of this model. RESULTS: A total of 126 breast cancer patients were ultimately included in our study, 38 (53.5%) patients were diagnosed with non-SLN metastases of all 71 patients in training set. The results of multifactorial logistic analysis suggested that lymph node metastasis ratio (LNR), short axis of lymph node and progesterone receptor (PR) were strongly associated with non-SLN metastasis. We established a nomogram using the above three variables as predictors, which yielded an area under the curve of 0.795, and validated with a favorable AUC of 0.876. CONCLUSION: The nomogram we constructed can accurately predict the likelihood of non-SLN metastasis in our patients with 1-3 positive SLN after NAT, which may help guide decision making regarding axillary management.
Assuntos
Neoplasias da Mama , Metástase Linfática , Mastectomia , Terapia Neoadjuvante , Nomogramas , Biópsia de Linfonodo Sentinela , Linfonodo Sentinela , Humanos , Feminino , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Neoplasias da Mama/terapia , Pessoa de Meia-Idade , Estudos Retrospectivos , Terapia Neoadjuvante/métodos , Biópsia de Linfonodo Sentinela/métodos , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia , Linfonodo Sentinela/diagnóstico por imagem , Adulto , Axila , Prognóstico , Excisão de Linfonodo/métodos , Seguimentos , Idoso , Linfonodos/patologia , Linfonodos/cirurgia , Curva ROC , Estadiamento de Neoplasias , Carcinoma Ductal de Mama/cirurgia , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/secundário , Carcinoma Ductal de Mama/terapiaRESUMO
Synchronous prostatic adenocarcinoma found in patients with muscle-invasive bladder cancer (MIBC) that undergo radical cistoprostatectomy is not uncommon. Nonetheless, the occurrence of collision metastasis, where both prostate cancer and bladder cancer involve the same lymph node, is exceptionally uncommon, with few cases being reported in the literature. We present a case of a 65-year-old patient diagnosed with MIBC who underwent laparoscopic radical cistoprostatectomy with extended lymph node dissection and intracorporeal ileal conduit. The final pathology revealed urothelial carcinoma pT3bN1 as well as prostatic adenocarcinoma pT3bN1. One lymph node presented metastasis from both bladder cancer and prostate cancer.
Assuntos
Metástase Linfática , Neoplasias da Próstata , Neoplasias da Bexiga Urinária , Humanos , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia , Masculino , Idoso , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Prostatectomia/métodos , Linfonodos/patologia , Excisão de Linfonodo/métodosRESUMO
BACKGROUND: The optimal number of lymph nodes to be dissected during lung cancer surgery to minimise the postoperative recurrence risk remains undetermined. This study aimed to elucidate the impact of the number of dissected lymph nodes on the risk of postoperative recurrence of non-small cell lung cancer (NSCLC) using machine learning algorithms and statistical analyses. METHODS: We retrospectively analysed 650 patients with NSCLC who underwent complete resection. Five machine learning models were trained using clinicopathological variables to predict postoperative recurrence. The relationship between the number of dissected lymph nodes and postoperative recurrence was investigated in the best-performing model using Shapley additive explanations values and partial dependence plots. Multivariable Cox proportional hazard analysis was performed to estimate the HR for postoperative recurrence based on the number of dissected nodes. RESULTS: The random forest model demonstrated superior predictive performance (area under the receiver operating characteristic curve: 0.92, accuracy: 0.83, F1 score: 0.64). The partial dependence plot of this model revealed a non-linear dependence of the number of dissected lymph nodes on recurrence prediction within the range of 0-20 nodes, with the weakest dependence at 10 nodes. A linear increase in the dependence was observed for ≥20 dissected nodes. A multivariable analysis revealed a significantly elevated risk of recurrence in the group with ≥20 dissected nodes in comparison to those with <20 nodes (adjusted HR, 1.45; 95% CI 1.003 to 2.087). CONCLUSIONS: The number of dissected lymph nodes was significantly associated with the risk of postoperative recurrence of NSCLC. The risk of recurrence is minimised when approximately 10 nodes are dissected but may increase when >20 nodes are removed. Limiting lymph node dissection to approximately 20 nodes may help to preserve a favourable antitumour immune environment. These findings provide novel insights into the optimisation of lymph node dissection during lung cancer surgery.
Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Excisão de Linfonodo , Aprendizado de Máquina , Recidiva Local de Neoplasia , Humanos , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/patologia , Estudos Retrospectivos , Masculino , Feminino , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Carcinoma Pulmonar de Células não Pequenas/patologia , Pessoa de Meia-Idade , Idoso , Excisão de Linfonodo/métodos , Linfonodos/patologia , Metástase Linfática , Pneumonectomia/métodosRESUMO
AIM: The aim of this study was to assess whether the use of sentinel lymph node (SLN) in addition to lymphadenectomy was associated with survival benefit in patients with early-stage cervical cancer. METHODS: International, multicenter, retrospective study. INCLUSION CRITERIA: cervical cancer treated between 01/2007 and 12/2016 by surgery only; squamous cell carcinoma, adenocarcinoma, adenosquamous carcinoma, FIGO 2009 stage IB1-IIA2, negative surgical margins, and laparotomy approach. Patients undergoing neo-adjuvant and/or adjuvant treatment and/or with positive para-aortic lymph nodes, were excluded. Women with positive pelvic nodes who refused adjuvant treatment, were included. Lymph node assessment was performed by SLN (with ultrastaging protocol) plus pelvic lymphadenectomy ('SLN' group) or pelvic lymphadenectomy alone ('non-SLN' group). RESULTS: 1083 patients were included: 300 (27.7 %) in SLN and 783 (72.3 %) in non-SLN group. 77 (7.1 %) patients had recurrence (N = 11, 3.7 % SLN versus N = 66, 8.4 % non-SLN, p = 0.005) and 34 (3.1 %) (N = 4, 1.3 % SLN versus N = 30, 3.8 % non-SLN, p = 0.033) died. SLN group had better 5-year disease-free survival (DFS) (96.0 %,95 %CI:93.5-98.5 versus 92.0 %,95 %CI:90.0-94.0; p = 0.024). No 5-year overall survival (OS) difference was shown (98.4 %,95 %CI:96.8-99.9 versus 96.8 %,95 %CI:95.4-98.2; p = 0.160). SLN biopsy and lower stage were independent factors associated with improved DFS (HR:0.505,95 %CI:0.266-0.959, p = 0.037 and HR:2.703,95 %CI:1.389-5.261, p = 0.003, respectively). Incidence of pelvic central recurrences was higher in the non-SLN group (1.7 % versus 4.5 %, p = 0.039). CONCLUSION: Adding SLN biopsy to pelvic lymphadenectomy was associated with lower recurrence and death rate and improved 5-year DFS. This might be explained by the lower rate of missed nodal metastasis thanks to the use of SLN ultrastaging. SLN biopsy should be recommended in patients with early-stage cervical cancer.
Assuntos
Excisão de Linfonodo , Linfonodo Sentinela , Neoplasias do Colo do Útero , Humanos , Feminino , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/mortalidade , Excisão de Linfonodo/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia , Adulto , Idoso , Estadiamento de Neoplasias , Biópsia de Linfonodo Sentinela/métodos , Metástase Linfática , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/mortalidadeRESUMO
INTRODUCTION: Seroma is the most common early complication following surgical breast cancer treatment. Its development is associated with pain, scar complications, adjuvant therapy delays, the need for outpatient visits, and increased care costs. OBJECTIVE: Assess seroma incidence and risk factors in women undergoing mastectomies. METHOD: This study comprises a prospective cohort encompassing women aged 18 or over undergoing mastectomies as a breast cancer treatment. Patients underwent physiotherapy on the 1st, 7th, and 30th postoperative days for kinetic-functional, skin, and wound healing assessments and were attended to by nurses for surgical wound care, draining liquid on the 7th, 14th, and 21st postoperative days. Seroma was defined as the presence of local fluctuations requiring puncture, regardless of the punctured volume. RESULTS: A total of 249 women were evaluated, with a mean age of 57.5 (SD = 11.8). A total of 77.1% were classified as overweight or obese, 60.2% were hypertensive, 21.3% were diabetic, 66.7% underwent neoadjuvant chemotherapy and 62.7% underwent axillary lymphadenectomies. Seroma incidence was 71.1%, requiring, on average, two aspiration punctures until condition resolution. Overweight or obese women and those who underwent axillary lymphadenectomies exhibited 1.92- and 2.06-fold higher risk for seroma development (OR = 1.92; 95% CI 1.02-3.61; p = 0.042; and OR = 2.06; 95% CI 1.17-3.63; p = 0.012), respectively. CONCLUSION: Seroma incidence was very high. Being overweight or obese and undergoing axillary lymphadenectomy comprise independent seroma development risk factors. This study is part of a randomized clinical trial evaluating the effectiveness of applying compressive taping to prevent post-mastectomy seroma, which was approved by the Brazilian National Cancer Institute, Research Ethics Committee (2,774,824), and it is registered in the ClinicalTrials.gov (NCT04471142, on July 15, 2020).
Assuntos
Neoplasias da Mama , Mastectomia , Seroma , Humanos , Feminino , Seroma/etiologia , Seroma/epidemiologia , Neoplasias da Mama/cirurgia , Pessoa de Meia-Idade , Fatores de Risco , Estudos Prospectivos , Incidência , Mastectomia/efeitos adversos , Mastectomia/métodos , Idoso , Adulto , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Estudos de CoortesRESUMO
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.
Assuntos
Neoplasias Colorretais , Estudos de Viabilidade , Verde de Indocianina , Excisão de Linfonodo , Linfonodos , Humanos , Verde de Indocianina/administração & dosagem , Neoplasias Colorretais/patologia , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/cirurgia , Projetos Piloto , Feminino , Masculino , Idoso , Linfonodos/patologia , Linfonodos/diagnóstico por imagem , Pessoa de Meia-Idade , Excisão de Linfonodo/métodos , Metástase Linfática/patologia , Metástase Linfática/diagnóstico por imagem , Corantes , Fluorescência , Imagem Óptica/métodos , Idoso de 80 Anos ou mais , Corantes Fluorescentes/administração & dosagemRESUMO
Our goal was to examine the postoperative indicators after the first 300 thoracic robotic cases in the National Institute of Oncology. We retrospectively analyzed the clinicopathological and postoperative indicators of the first 300 patients. We also compared the first 30 cases performed by one surgeon to his 30 VATS (video-assisted thoracic surgery) and open cases. The average hospital stay was 5.2 days, the chest tube was removed on the second day. Conversion, need for reoperation and morbidity was low (1.8%, 2% and 10.6%, respectively). The change in operating time slows down after 20 cases. The hospital stay and complications were slightly favorable with RATS (robotic-assisted thoracic surgery) than with VATS. The intensive care stay, however, was significantly shorter while the amount of removed lymph nodes was significantly higher in RATS procedures. As a conclusion, RATS is a safe technique in thoracic surgery. Moreover, more lymph nodes are removed with RATS which can lead to better staging.
Assuntos
Tempo de Internação , Procedimentos Cirúrgicos Robóticos , Cirurgia Torácica Vídeoassistida , Humanos , Masculino , Cirurgia Torácica Vídeoassistida/métodos , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos , Feminino , Idoso , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/patologia , Duração da Cirurgia , Adulto , Resultado do Tratamento , Excisão de Linfonodo/métodos , Hungria , Robótica/métodosRESUMO
Robot-assisted surgery has been available at the National Institute of Oncology since 2022. We report on the most important parameters of the colorectal robot-assisted surgery of the first 191 patients. Robotically assisted rectal surgery was compared with our previous laparoscopic and open surgical activities. Perioperative indicators of rectal cancer patients operated laparoscopically (n=225) and open (n=213) were retrospectively compared with patients operated robotically assisted (n=140). In comparison of the three groups (laparoscopic, open, robot-assisted), robotic surgery shows a significant advantage in quality of mesorectal excision (complete TME rate 77%, 72.7% and 90%, respectively), in the days of care (median 7, 9 and 5 days, respectively), hospital readmissions (8%, 16%, 6.4%), and the rate of sphincter preservation (68%, 60% and 89.5%). As a conclusion, robotic surgery is sufficiently safe from oncological point of view. It has a significant advantage in quality of lymph node dissection, shorter care, fewer hospital readmissions, partially lower morbidity rate and a higher sphincter preservation rate compared to laparoscopic and open surgeries.