左侧肺癌切除联合区域淋巴结清扫手术病人淋巴结转移与临床病理的关系分析

目的 分析左侧肺癌切除联合区域淋巴结清扫手术淋巴结转移规律与临床病理的关系.方法 2017年2月～2019年2月我院收治的行左侧肺癌切除联合区域淋巴结清扫术病人90例,分析淋巴结转移规律和危险因素相关性.结果 左肺上叶转移数高于左肺下叶,差异有统计学意义(P<0.05).小细胞癌转移数高于腺癌和鳞癌,鳞癌高于腺癌,差异...     

食管癌淋巴结清扫的现状与进展

正食管癌和肺癌是胸外科最常见的两大恶性肿瘤,世界各国胸外科医师对于肺癌手术清扫的标准、范围及强度渐渐趋于相同。但是对于食管癌的淋巴结清扫规范,因为各国各地区的病理类型、认知程度及手术的标准化不同,食管癌的外科手术仍然存在较多争议。在国内,尤其是对于食管癌淋巴结清扫的手术入路、清扫范围、微创技术淋巴结清扫等仍有不同的见解。随着食管癌规范化治疗和新技术的普及,在很多方面胸     

直肠癌侧方淋巴结清扫手术指征和清扫范围

侧方淋巴结转移是低位直肠癌的重要转移途径,放化疗对其疗效不佳,影响直肠癌病人预后。侧方淋巴结清扫作为一种有效的治疗手段,随着腹腔镜手术的普及和外科医生手术技巧的提高,被越来越广泛的应用于临床。但直肠癌侧方淋巴结清扫领域很多问题尚存争议,制约了该技术的推广和疗效评价,这其中以直肠癌侧方清扫手术指征的把握和清扫范围如何界定最为突出。中日两国学者针对上述问题开展了相关研究并得出了初步结论,但这些结论尚需更高级别的循证医学证据来证实。     

淋巴结清扫手术治疗胃癌的现状

几十年来，淋巴结清扫的范围始终是胃癌手术治疗争议的热门话题。广泛淋巴结清扫（ｅｘｔｅｎｄｅｄｌｙｍｐｈｎｏｄｅｄｉｓｅｃｔｉｏｎ，ＥＬＮＤ）由阵内（ｊｉｎｎａｉ）于６０年代推介，其对并发症和长期生存的影响的意见很不一致。基本上有两大流派，大多数日本、...     

肝癌淋巴结转移手术治疗进展

<正>肝细胞癌(以下简称肝癌)的发病率在全世界恶性肿瘤中排名第3位[1]。我国是肝癌的高发国家[2]。手术切除仍然是目前最有效的根治肝癌的方法,但对于术中是否行淋巴结清扫还没有统一的结论。在肝外胆管癌的手术治疗中,常规清扫肝周淋巴结已达成共识[3]。然而,对于原发或继发性肝癌,目前仍然争议不断。相对于其他常见的恶性肿瘤,肝癌淋巴结转移(lymph node metastasis,LNM)的发生率较低。Watanabe等[4]在一项     

胃癌淋巴结清扫的理论基础与历史地位

淋巴结转移是胃癌最常见的转移方式,清除与胃癌转移密切相关的淋巴结是胃癌根治术的主要内容,也是胃癌外科治疗由简单的胃切除术发展为胃癌根治术的主要标志.可以说,近半个多世纪以来胃癌治疗的进步,除了早期癌的诊断与治疗外,主要得益于对胃癌淋巴转移规律的认识与淋巴结清扫.     

胃癌淋巴结清扫方法与策略进展

<正>胃癌是常见的消化道恶性肿瘤,据卫生部统计其居我国恶性肿瘤病死率的第3位。手术切除是治疗胃癌的主要手段,但是目前外科医生对胃癌的手术切除仍然存在很多争议,关注最多的是淋巴结清扫。现将有关研究结果综述如下。1早期胃癌日本学者Kojima等[1]报告9.1%的淋巴结阴性,临床诊     

全胸腔镜肺癌根治术淋巴结清扫的探讨

目的探讨全胸腔镜下肺叶切除治疗临床Ⅰ期非小细胞肺癌淋巴结清扫的安全性和可行性。方法 2006年1月～2008年12月,160例临床Ⅰ期非小细胞肺癌接受全腔镜下肺叶切除术、纵隔淋巴结清扫,采用不撑开肋骨三孔法,并与同期247例接受常规开放手术的Ⅰ期非小细胞肺癌进行比较。结果胸腔镜组淋巴结清扫组数(2.4±1.5)组与开胸组(2.6±1.6)组无显著差异(t=1.262,P=0.208),胸腔镜组清扫淋巴结(9.8±6.2)枚,与开胸组(9.9±5.9)枚无统计学差异(t=-0.160,P=0.873)。开胸组并发症发生率11.7%(29/247)和围手术期死亡率2.8%(7/247)与胸腔镜组并发症发生率9.4%(15/160)和围手术期死亡率0.6%(1/160)无显著差异(χ2=0.564,P=0.453;χ2=1.446,P=0.229)。胸腔镜组生存情况优于开胸组(χ2=5.373,P=0.020)。结论全胸腔镜肺叶切除术治疗临床Ⅰ期非小细胞肺癌在技术上是安全可行的,其淋巴结清扫可达到开放手术的范围,远期疗效不亚于开放手术。     

胃癌的淋巴结清扫及意义

胃癌是目前我国死亡率较高的恶性肿瘤之一。胃癌的浸润深度（T）和淋巴结转移程度（N）是评价肿瘤分期的重要依据,UICC及日本胃癌规约均认为淋巴结转移情况是评价胃癌预后的独立且重要的因素,因此,胃癌的淋巴结清扫程度与胃癌预后关系密切。东西方学者对胃癌淋巴结清扫范围的争论已持续多年,但越来越多的学者趋向于把D2清扫术作为胃癌治疗的标准术式。     

早期胃癌的手术方式与淋巴结清扫

<正>对早期胃癌治疗的进步主要得益于人们对其临床病理认识的深入与治疗手段的提高。最初人们仅以胃切除术治疗胃癌,以切除胃癌原发灶为主要目的,其时提高胃切     

胃癌的淋巴结转移与清扫研究进展

目的总结并分析目前胃癌外科手术中关于淋巴结转移与清扫的不同观点。方法对当前国内外有关胃癌淋巴结转移与清扫方法的研究报道进行综述和分析。结果胃癌周围淋巴结清扫是根据临床分期和肿瘤的位置整块清除周围淋巴结;腹腔镜下胃癌根治术安全、可行、有效、创伤小且近期、远期效果良好;前哨淋巴结在临床上应用于对早期胃癌的评估是可行的,准确率和敏感性均较高;胃癌周围淋巴结显像是一种有效、易行和安全的方法,对胃癌淋巴结清扫有指导作用;胃癌的循证外科治疗给淋巴结清扫的范围提供了一个新的视角。结论精确评估各种清扫方法是困难和复杂的,需要世界范围内的胃肠外科学者加强合作,互相取长补短,进行深入研究,这样才能得出令人信服的一致结论,并最终形成临床实践的指导原则。     

进展期远端胃癌D2根治术No.12b组淋巴结清扫60例分析

目的探讨进展期远端胃癌行D2根治术时No.12b组淋巴结清扫的必要性及可行性,及No.12b组淋巴结转移与临床病理因素的关系。方法回顾性收集60例进展期远端胃癌患者的病例资料,患者行D2或D2^＋根治术,并均加行No.12b组淋巴结清扫术。分析No.12b组淋巴结转移与临床病理因素的关系。结果全组无手术死亡病例,无严重并发症发生。60例患者中发现12例有No.12b组淋巴结转移,转移率为20.00%。其中BorrmannⅢ、Ⅳ型者No.12b组淋巴结转移率为31.25%（10/32）,淋巴结转移N2～3期者为30.30%（10/33）,肿瘤浸润T3～4期者为29.73%（11/37）,明显高于BorrmannⅠ、Ⅱ型〔7.14%（2/28）〕,N0～1期〔7.41%（2/27）〕及T1～2期者〔4.35%（1/23）〕,P〈0.05;No.12b组淋巴结转移与肿瘤的大小无关（P〉0.05）。结论 No.12b组淋巴结清扫术对于进展期胃远端癌是必要且可行的,其远期效果有待大样本的前瞻性研究进一步证实。     

进展期远端胃癌D_2根治术No.12b组淋巴结清扫60例分析

目的探讨进展期远端胃癌行D2根治术时No.12b组淋巴结清扫的必要性及可行性,及No.12b组淋巴结转移与临床病理因素的关系。方法回顾性收集60例进展期远端胃癌患者的病例资料,患者行D2或D2+根治术,并均加行No.12b组淋巴结清扫术。分析No.12b组淋巴结转移与临床病理因素的关系。结果全组无手术死亡病例,无严重并发症发生。60例患者中发现12例有No.12b组淋巴结转移,转移率为20.00%。其中BorrmannⅢ、Ⅳ型者No.12b组淋巴结转移率为31.25%(10/32),淋巴结转移N2～3期者为30.30%(10/33),肿瘤浸润T3～4期者为29.73%(11/37),明显高于BorrmannⅠ、Ⅱ型〔7.14%(2/28)〕,N0～1期〔7.41%(2/27)〕及T1～2期者〔4.35%(1/23)〕,P0.05;No.12b组淋巴结转移与肿瘤的大小无关(P0.05)。结论 No.12b组淋巴结清扫术对于进展期胃远端癌是必要且可行的,其远期效果有待大样本的前瞻性研究进一步证实。     

Lymph node classification of esophageal squamous cell carcinoma and adenocarcinoma

The lymphatic channels of the esophagus run vertically along the axis of the esophagus and some of them drain into the cervical lymph glands upwards and into the abdominal glands downwards, and the pattern of lymph node metastasis of esophageal carcinoma is widespread. In various classifications of pattern of lymphatic spread, four classifications were proposed; location, number, ratio, and size. No definite survival advantage of aggressive lymph node dissection during esophagectomy has been proved compared with less dissection. Stage migration, micrometastasis, and sentinel lymph node concept all make it possible to individualize surgical management of esophageal carcinoma as a part of various multimodal treatments. Early diagnosis, standardization of surgery including routine lymph node dissection, and perioperative management of patients have all led to better survival rates of esophageal carcinoma.     

Lymph node metastasis in bladder cancer

OBJECTIVE: We reviewed the literature on nodal staging in patients with bladder cancer treated with radical cystectomy and lymphadenectomy. RESULTS: Fractionating the lymph node specimen significantly increases the node count, whereas results are contradictory as to whether that increase improves detection of positive nodes. Pathoanatomic data indicate that extending lymph node dissection to the aortic bifurcation improves nodal staging. That approach might be beneficial, especially in cases of T3/T4a tumours, which more often have lymph node metastases above the iliac bifurcation as compared to less advanced tumours. In node-negative patients, extended lymph node dissection probably removes undetected micrometastases and thereby increases disease-free survival. Four studies suggested that a minimum of 8, 10, 10-14, and 16 nodes must be removed, to improve survival, and in another investigation aortic bifurcation was proposed as the upper limit for dissection. Some patients with positive nodes can be cured by surgery alone, even those with gross adenopathy. There is no evidence that extended lymphadenectomy increases surgery-related morbidity. The TNM classification is apparently insufficient for stratifying node-positive patients because several larger cystectomy series could not verify differences in survival between N groups. CONCLUSIONS: Fractionating the lymphadenectomy specimen increases the lymph node count. In node-negative patients, more meticulous and extended lymph node dissection (8-16 nodes or to the aortic bifurcation) probably improves disease-free survival by removing undetected micrometastases. Patients with positive lymph nodes should also be offered radical cystectomy.     

Surgical Treatment for Lung Cancer in Octogenarians

Purpose We conducted this study in order to determine how we should perform the surgical treatment for clinical stage I non-small cell lung cancer (NSCLC) in octogenarians.Methods Thirty-three octogenarians with clinical stage I NSCLC participated in this study. They were retrospectively divided into two groups: one group of 11 patients who underwent a lymph node dissection (ND group), and one group of 22 patients who did not undergo this procedure (ND0 group). We analyzed the surgical invasiveness, morbidity, mortality, and survival in both groups.Results The morbidity rate in the ND group (45%) was higher than that in the ND0 group (23%); however, the difference was no statistically significant (P = 0.1805). There was no significant difference in the overall survival rates of the two groups (P = 0.1647), and the median survival time of the ND0 group (76 months) was slightly longer than that of the ND group (26 months). There was no significant difference in local recurrence rate between the two groups (9.1% vs 4.5%, P = 0.6059).Conclusion We thus conclude that a limited operation without lymph node dissection might be the best surgical treatment for carefully selected octogenarians with clinical stage I NSCLC.     

Clinical Impact of Lymphadenectomy Extent in Resectable Esophageal Cancer

Esophageal cancer (EC) frequently presents with advanced stages and is associated with high recurrence rates after esophagectomy. The value of an extended lymph node dissection (ELND) remains unclear in this setting. An EC data set was created from the Surveillance, Epidemiology, and End-Results 1973–2003 database. Relationships between the number of lymph nodes (LNs) examined and overall survival (OS) were analyzed. From a cohort of 40,129 EC patients, 5,620 individuals were selected. The median age was 65 (range: 11–102), and 75% were men. The median tumor size was 5.0 cm (0.1–30). On multivariate analysis, total LN count (or negative LN count, respectively) was an independent prognostic variable, aside from age, race, resection status, radiation, T category, N category (all at p < 0.0001), and M category (p = 0.0003). Higher total LN count (>30) and negative LN count (>15) categories were associated with best OS and lowest 90-day mortality (p < 0.0001). The numeric LN effect on OS was independent from nodal status or histology. Greater total and negative LN counts are associated with longer EC survival. Although the mechanism remains uncertain, it does not appear to be limited to stage migration. ELND during potentially curative esophagectomy for EC can be supported by the data.