Successful Laparoscopic Treatment of Chylous Ascites after Pelvic Lymphadenectomy: A Case Report and Peanut Oil Application

A 23-year-old female patient with refractory chylous ascites was successfully treated with laparoscopic ligation of the ruptured lymphatic vessel. The young patient developed abdominal distention after right-side pelvic lymph node dissection for dysgerminoma of the right ovary. Conservative managements failed to control the symptoms. Laparoscopic surgery was performed after oral administration of peanut oil, revealing the presence of a whitish fluid in the abdominal cavity. The responsible lesion of the chylous ascites was detected in the right obturator fossa and ligated with the HEM-O-LOK System (Kangji Medical Instrument Co., Ltd., Hangzhou City, Zhejiang Province, China). The patient experienced an uneventful recovery and has been completely free of symptoms for 1 year. Laparoscopic surgery should be considered as a treatment of choice for intractable chylous ascites, and peanut oil could be used before surgery as an effective way to facilitate detection of the leakage during surgery.     

Current controversies and developments on the role of lymphadenectomy for penile cancer

Penile squamous cell carcinoma is a rare cancer in men. The main prognosticators of survival for penile cancer patients remain the presence and the extent of lymph node metastasis. While radical inguinal lymphadenectomy has been the cornerstone of regional lymph node management for many years, it is still associated with significant morbidity and psychological distress. Recent developments in penile squamous cell carcinoma management have been met with some controversy in the urologic oncology community. Herein, we review the current controversies and developments on the role of inguinal lymphadenectomy for penile cancer.     

Prophylactic incisional negative pressure wound therapy shows promising results in prevention of wound complications following inguinal lymph node dissection for Melanoma: A retrospective case-control series

BackgroundInguinal lymphadenectomy (ILND) for melanoma is associated with a number of complications including seroma, surgical site infection (SSI), and lymphedema. Incisional negative pressure wound therapy (iNPWT) has shown promising results in preventing postoperative morbidity across a wide variety of surgical procedures, but these results are yet to be investigated in patients undergoing ILND for melanoma.MethodsIn this study, we reviewed the data of 55 melanoma patients treated with ILND between January 2015 and January 2017 at Odense University Hospital. Patients were followed up until April 2018 for the occurrence of seroma, SSI, and lymphedema. We used prophylactic iNPWT after ILND in 14 patients and compared their morbidity outcomes with the 41 patients receiving standard postoperative wound care in the same period.ResultsThe iNPWT intervention significantly reduced seroma compared to the control group (28.6% vs. 90.3%, p < 0.001) and had a trending impact on wound infection (42.9% vs. 65.9%, p = 0.13). The effect was not significant for the prevention of lymphedema (35.7% vs. 51.2%, p = 0.33). Because the iNPWT group had relatively fewer incidences of seroma, SSI, and lymphedema, the iNPWT intervention was more cost-effective than conventional wound care (US$911.2 vs. US$2542.7, p < 0.05).ConclusionThe use of prophylactic iNPWT significantly reduced seroma formation following ILND. These promising results, however, need to be confirmed in a future prospective randomized trial.     

ATA practice guidelines for the treatment of differentiated thyroid cancer: were they followed in the United States?

Background

The aim of this study was to benchmark national practice patterns against American Thyroid Association guidelines for thyroidectomy, lymphadenectomy, and radioactive iodine (RAI) for differentiated thyroid cancer (DTC).

Methods

A cross-sectional analysis of patients with DTC in Surveillance, Epidemiology, and End Results was performed. Outcomes were practice accordance with guidelines for extent of surgery and RAI treatment. Predictors of accordance were identified.

Results

A total of 52,964 patients with DTC were included. Seventy-six percent were women, and 83% white. There was 71% accordance with surgery recommendations; among these, 15% underwent central lymphadenectomy, 31% had RAI but no lymphadenectomy, and 25% had RAI and lymphadenectomy. The highest accordance with guidelines was for patients aged <45 years with stage II disease (80%); the lowest accordance was for patients aged ≥45 years with stage II disease (52%). Patients aged >65 years and of black race had the lowest accordance (P < .001).

Conclusions

Variation in practice suggests variation in the quality of care for DTC. Greater dissemination of evidence-based recommendations is needed for elderly and minority patients.     

淋巴结清扫数目对无淋巴结转移胃癌患者预后的影响

目的 探讨胃癌根治术中淋巴结清扫数目对无淋巴结转移患者预后的影响.方法 回顾性分析1995年1月至2004年12月期间221例施行D2根治术、术后经病理证实无淋巴结转移的胃癌患者的临床资料.对本组患者预后因素进行单因素及多因素分析,分析淋巴结清扫数目与术后5年生存率及术后并发症发生率的关系.结果 221例无淋巴结转移胃癌患者术后5年生存率为83.5%.淋巴结清扫数目是影响本组患者预后的独立因素之一.相同浸润深度患者的术后5年生存率有随淋巴结清扫数目的 增加而增高的趋势(P<0.05).淋巴结清扫数目pT1.2期≥15枚、pT3期≥20枚时,患者术后5年生存率较高(P<0.05).本组患者术后并发症发生率为10.8%,淋巴结清扫数目与术后并发症发生率的无显著相关性(P>0.05).结论 淋巴结清扫数目是无淋巴结转移胃癌患者的独立预后因素,应积极争取清扫足够的淋巴结,以提高疗效;合理的淋巴结清扫数目并不增加患者术后并发症的发生率.     

腹腔镜根治性全胃切除治疗胃底贲门癌的临床研究

目的 探讨腹腔镜根治性全胃切除治疗胃底贲门癌的临床疗效和可行性.方法 回顾性分析2007年4月至2009年4月福建医科大学附属协和医院收治的176例胃底贲门癌行根治性全胃切除患者的临床资料,其中腹腔镜全胃切除81例(LATG组),开腹全胃切除95例(OTG组).比较两组患者术中及术后、淋巴结清扫、并发症发生率及病死率情况.计量资料采用t检验,计数资料采用x2检验.结果 两组患者均成功完成手术.LATG组和OTG组患者术中出血量分别为(98±84)ml和(339±245)ml,术中输血例数分别为3例和19例,术后肛门排气时间分别为(3.9±1.1)d和(5.0±1.6)d,术后住院时间分别为(13±5)d和(15±5)d,其差异有统计学意义(t=4.16,x2=6.82,t=4.57,2.83,P<0.05).LATG组和OTG组患者平均淋巴结清扫数目分别为(28±12)枚和(29±11)枚,其差异无统计学意义(t=0.42,P＞0.05);按肿瘤浸润深度进行分层分析,LATG组和OTG组患者T1、T2、T3期平均淋巴结清扫数目分别为(21±8)、(25±7)、(29±11)枚和(29±12)、(31±9)、(28±11)枚,其差异无统计学意义(t=1.53,1.90,0.65,P＞0.05).LATG组和OTG组患者术后并发症发生率和病死率分别为11%(9/81)、0和19%(18/95)、1%(1/95),其差异无统计学意义(x2=2.07,1.18,P＞0.05).结论 腹腔镜根治性全胃切除能达到与开腹手术相同的根治效果,且具有安全、术后恢复快等优点.     

Is it justified to classify patients to Stage IIIC epithelial ovarian cancer based on nodal involvement only?

BACKGROUND: Stage IIIC epithelial ovarian cancer is generally associated with upper abdominal tumor implants of greater than 2 cm and carries a grave prognosis. A subset of patients is upstaged to Stage IIIC because of lymph node metastases, in which prognosis is not well defined. We undertook this study to describe the clinical behavior of occult Stage IIIC. METHODS: All consecutive patients found to have Stage IIIC epithelial ovarian cancer during a 9-year period (1994-2002) were analyzed for surgical procedures, pathology, and disease-free (DFS) and overall survival (OS). RESULTS: Thirty-six patients were upstaged to Stage IIIC by virtue of positive nodes. Nine had small volume upper abdominal disease (IIIA/B before upstaging), 15 had disease limited to the pelvis and 12 had disease confined to the ovaries. 32/36 patients had no gross residual disease at the conclusion of surgery. The 5-year DFS and OS survivals were 52% and 76% respectively, for all patients. We observed no significant difference in outcomes between patients upstaged from IIIA/B versus I-II stage disease. The outcomes were superior to a control group of patients cytoreduced to either no gross RD or RD<1 cm, who had large volume upper abdominal disease at beginning of surgery (p<0.001). CONCLUSIONS: Patients upstaged to Stage IIIC epithelial ovarian cancer for node involvement have an excellent 5-year OS relative to all patients with Stage IIIC disease. These data demonstrate the necessity for stratifying patients classified as having Stage IIIC disease based solely on nodal disease when comparing outcomes. This information is particularly valuable when counseling patients regarding prognosis.     

Oesophageal cancer: How radical should surgery be?

Introduction

Oesophagectomy for carcinoma can be viewed as comprising two components: resection of the oesophagus and resection of the enveloping lymphatics. Controversy exists regarding how extensive these two components should be.

Methods

Through a literature overview, the aim of this educational article is to provide surgeons with arguments to understand which operation is the most oncologically sound according to patient and tumour parameters.

Results

Non-randomised comparative studies evaluating radical lymphadenectomy have reported controversial survival benefit. Independent association found between the number of surgically removed lymph nodes and overall survival is an indirect evidence supporting radical lymphadenectomy. The only phase III trial comparing non-radical transhiatal oesophagectomy with transthoracic oesophagectomy for patients with oesophageal adenocarcinoma found 5-year survival rates of 29% vs. 39%, respectively. Although not statistically significant due to underpowered study, specialists would consider less of an increase in survival to be clinically relevant. For squamous OC, the first small randomised controlled trial comparing 2-field lymphadenectomy to 3-field lymphadenectomy did not found significant 5-year survival difference (48% vs. 66%) and the second one comparing 2-field lymphadenectomy to lymph node sampling identified a survival benefit favoring radical resection (36% vs. 25%).

Conclusion

Radical transthoracic oesophagectomy with two-field lymphadenectomy appears to offer an optimal balance between benefits and risks to a majority of OC patients, especially in the growing area of neoadjuvant treatments. Non-radical resection should be probably reserved for patients with a poor general status whereas 3-field lymphadenectomy may be reserved to selected patients with loco-regional disease in experienced hands, surely for patients with upper OC.