Surgical outcome after the clearance of abdominal metastatic lymph nodes in 138 patients with thoracic esophageal carcinoma

BACKGROUND: Although abdominal lymph node metastasis in patients with thoracic esophageal squamous cell carcinoma (SCC) has been reported to be a risk factor to reduce long-term survival, only a few studies have so far evaluated the clinicopathologic factors among this group of patients. The purpose of this study was to evaluate the patients' surgical outcome after the clearance of metastatic abdominal nodes. PATIENTS AND METHODS: From 1980 to 2002, 550 consecutive patients with thoracic esophageal SCC underwent surgery with an abdominal lymph node dissection. A total of 138 patients with abdominal lymph node metastases were curatively resected. Those patients, including 62 from 1980 to 1989 and 76 from 1990 to 2002, were retrospectively reviewed. Univariate and multivariate analyses were performed to evaluate the impact of clinicopathologic factors on the survival of these patients. RESULTS: The overall 5-year survival rate of the 138 patients with abdominal lymph node metastases was 23%. A univariate analysis revealed that the following groups showed a greater than 30% overall 5-year survival rate: patients with T1 or T2 tumors, patients without thoracic node metastases, and those with poorly differentiated type tumors. Good prognostic factors based on a multivariate analysis were the most recent time period of surgery and 4 or fewer positive nodes. CONCLUSION: Among the patients with abdominal lymph node metastases, those with T1 or T2 tumors, patients without thoracic node metastases, and patients with 4 or fewer positive nodes showed an acceptable overall survival after a curative resection.     

Unique distribution patterns of metastatic lymph nodes in patients with superficial carcinoma of the thoracic oesophagus.

BACKGROUND: Lymph node metastasis is commonly found in carcinoma of the thoracic oesophagus, even when the tumour invades only the submucosa. Although lymph node status greatly influences the outcome, the pattern of early lymphatic spread has not been investigated, and the role of lymph node dissection is still a matter of controversy. METHODS: A series of 110 patients with superficial carcinoma who underwent systematic extended lymph node dissection was investigated retrospectively. RESULTS: Lymph node involvement was found in 0 per cent (none of nine), 23 per cent (five of 22) and 49 per cent (38 of 78) of tumours that invaded the lamina propria, muscularis mucosa and submucosa respectively. Anatomically distant lymph nodes (recurrent nerve nodes and perigastric nodes) were involved more frequently than other intrathoracic nodes adjacent to the main tumour. Only three patients had involvement limited to the intrathoracic group, and in carcinoma that invaded only the muscularis mucosae, all metastatic nodes were located at the thoracocervical junction or in the abdomen. The 5-year survival rate was 89 per cent in the node-negative group and 54 per cent in the node-positive group (P < 0.0003). CONCLUSION: The recurrent nerve nodes and perigastric nodes are the principal proximal regional lymph nodes involved in superficial carcinoma of the thoracic oesophagus. Systematic lymph node dissection, which included these nodes, yielded an acceptable and favourable outcome in patients with node-positive superficial carcinoma.     

Benefits and risks associated with dissection of three regional lymph nodes (bilateral cervical, thoracic and abdominal) in thoracic esophageal carcinoma

To obtain curability safely, we have employed dissection of three regional lymph nodes (the bilateral cervical, thoracic and abdominal lymph nodes) since 1983. The subjects were 111 (three regional group) of 158 patients with thoracic esophageal carcinoma operated on our department till 1988. When compared to 207 patients treated during the period from 1973 to 1982 (control group), the background factors of the subjects revealed that the three regional group included more patients with advanced carcinoma and more elderly patients over 70 years of age. Operative results were more favourable in the three regional group (5.3% vs 2.7%), although mean operative time was longer (5 hrs and 2 min vs 8 hrs and 38 min) and mean blood loss was higher (1,098ml vs 1,407ml). Moreover, the incidence of recurrent nerve paralysis was higher. Overall 5-year survival was 20.4% vs 22.3%, showing no significant difference. However, when stage distribution is taken into consideration, results in the three regional group may be regarded as improved. After dissection of the three regional lymphnodes, the pattern of lymph node metastasis of thoracic esophageal carcinoma has been made clearer to give useful information on the site in which further dissection of lymph node is required.     

Treatment outcome and prognosis of patients with lymph node recurrence of thoracic esophageal squamous cell carcinoma after curative resection

Background  

This study aimed to assess treatment outcome and factors influencing survival after lymph node recurrence of thoracic esophageal squamous cell carcinoma (SCC) after curative resection.     

改良脂肪清除术对直肠癌患者直肠系膜内淋巴结转移的诊断作用

目的 运用改良脂肪清除术处理直肠癌标本,并探讨直肠癌标本直肠系膜内淋巴结的数量、分布及转移规律.方法 选取2003年至2008年就诊于北京大学临床肿瘤学院的60例未经过新辅助治疗的中低位直肠癌患者设为研究组,行全直肠系膜切除术(TME)后,应用改良脂肪清除技术对标本进行处理.同期对照组50例患者于TME术后取直肠癌标本并采用福尔马林浸泡法固定24 h,常规手工检出系膜淋巴结.研究组直肠系膜被分割为前、后、左、右4个象限,每个象限被进一步分割为上、中、下3段.两组淋巴结检出率及淋巴结转移率比较采用t检验和X2检验.结果 (1)研究组共检出1436枚系膜淋巴结(平均23.9枚/例),对照组共检出525枚(平均10.5枚/例),两组比较差异有统计学意义(t=-12.153,P相似文献   

胸段食管鳞癌患者的喉返神经旁淋巴结转移特点

目的探究胸段食管鳞癌患者的喉返神经旁淋巴结转移特点。 方法回顾性分析福建协和医院胸外科2012年1月至2015年12月间收治的行胸腹腔镜联合食管癌切除术的294例胸段食管鳞癌患者的喉返神经旁淋巴结清扫及转移情况,并分析喉返神经旁淋巴结转移特点。 结果294例行喉返神经旁淋巴结清扫的患者中,有88例患者有喉返神经旁淋巴结转移,转移率为29.93%;共清扫喉返神经旁淋巴结1 899枚,转移淋巴结145枚,转移度为7.64%。胸段食管鳞癌患者左、右喉返神经旁淋巴结转移与肿瘤浸润深度、分化程度、脉管瘤栓均有显著相关性(P<0.05),但与性别、年龄、肿瘤部位无显著相关性(P>0.05)。 结论胸段食管鳞癌患者易发生喉返神经旁淋巴结转移。对于肿瘤浸润程度大、分化程度差、有脉管瘤栓的胸段食管鳞癌患者,应重视左、右两侧喉返神经旁淋巴结清扫。     

Prognosis of patients with carcinoma of the thoracic esophagus, with special reference to the number of metastatic lymph nodes and their metastatic portions

One hundred and sixty two patients (69 patients without lymph node metastases and 93 patients with positive node metastases) out of patients with thoracic esophageal carcinoma resected within the past 12 years were studied regarding prognostic factors, with special reference to the number of positive nodes and their metastatic portions. Among patients with positive nodes, 5 years survival rates were 14.5% in patients with one or two positive nodes, 16.3% in patients with positive nodes only in the abdomen, 14.3% in patients with positive nodes only in the thorax, and 17.8% in patients with regional lymph node metastases (n1(+) and n2(+)). While among patients with distant lymph node metastases (n3(+) and n4(+)), with more than three positive nodes, or with positive nodes both in the thorax and abdomen, almost all of them expired due to recurrence within three years. Patients with one or two positive nodes and with positive nodes only in the abdomen who underwent postoperative irradiation combined with chemotherapy had a better prognosis than patients treated with postoperative irradiation alone or patients receiving no combined therapy.     

Problems in therapy of thoracic esophageal cancer in view of recurrence in the lymph nodes

The forms of recurrence from the first onset were confirmed in 171 out of 776 patients with thoracic esophageal cancer excised at our Department from 1959 to 1987; 87 patients (50.9%) had recurrence in the lymph nodes. Postoperative radiation in order to prevent recurrence in the lymph nodes was useful for the prevention of recurrence in the cervical lymph nodes, but radiation myelopathy/radiation pneumonitis might be of therapeutic difficulty in patients with recurrence in the areas of radiation. Moreover, patients treated by irradiation were apt to be involved in visceral recurrence. Incidence of recurrence in the lymph nodes was less in patients who had dissection in three areas than that in patients who received dissection in one or two. However, recurrence was observed in the border region between the cervix and the thorax, on the left side of the trachea, in the anterior portion and on the left side of the hilum in the areas of dissection. Useful postoperative chemotherapy is desirable in consideration of the fact that recurrence in the lymph nodes was observed at the posterior region of the pharynx, at the temporal region and in the pelvis and that dissemination and visceral recurrence were increased.     

Determinants of outcome in elderly patients with positive sentinel lymph nodes

Background

Older women are less likely to receive standard of care treatment for breast cancer.

Methods

We examined variables that affected the outcome of elderly patients ≥70 years old among 1,470 patients with invasive cancer with positive sentinel lymph nodes (SLNs).

Results

Elderly patients were less likely to undergo mastectomy, completion axillary node dissection (ALND), adjuvant chemotherapy, and radiotherapy (RT) following breast-conserving therapy (BCT) compared with patients <70 years old. The 5-year risk of disease progression and cumulative incidence of breast cancer–specific deaths were not significantly different for both groups. On multivariate analysis, hormone receptor–negative status, number of metastatic lymph nodes, high nuclear grade, and tumor size were the factors independently associated with increased risk of disease progression.

Conclusions

Tumor factors were the primary determinants of breast cancer outcomes in our cohort. Elderly patients are less likely to receive aggressive surgical interventions and adjuvant therapy because of perceived life expectancy.     

Patterns of enlarged lymph nodes in patients with metastatic renal cell carcinoma

Objective

We reviewed the imaging studies of patients with known metastatic renal cell carcinoma (RCC) in order to more accurately assess where retroperitoneal lymphadenopathy occurs.

Methods

The database of patients with metastatic RCC was reviewed and 101 patients were found from 2002 to 2006. Each patient's CT scans were then reviewed. Twenty-seven retroperitoneal sections were defined for each patient, with 3 positions in each of the x-, y-, and z-axis. Lymph nodes greater than 1 cm were then counted for each section.

Results

Of the 101 patients, 31, of whom 28 qualified, were found to have retroperitoneal lymphadenopathy of a least 1 cm or greater. Two-thirds of nodes (87 out of 124) exhibited a suprahilar, intra-aortocaval, and retro-aortocaval trend of lymph node enlargement. Three patients (11%) had isolated infrahilar nodes, while 8 patients (29%) exhibited a skip lesion pattern by imaging criteria. Only 4 patients (14%) were noted to have lymph nodes that were confined to the ipsilateral (paraaortic or paracaval) nodes in the perihilar and infrahilar region, which would be readily accessible during renal surgery.

Conclusions

Lymphatic drainage in RCC is ill-defined, likely due to multiple lymphatic outflow channels. However, after a review of retroperitoneal lymphadenopathy imaging in patients with known metastatic RCC, there does seem to be a cephalad, posterior, and medial drainage pattern.     

Impact of esophageal flexion level on the surgical outcome in patients with sigmoid esophageal achalasia

Purpose

Esophageal achalasia can be roughly divided into non-sigmoid and sigmoid types. Laparoscopic surgery has been reported to be less than optimally effective for sigmoid type. The aim of this study was to examine the impact of the esophageal flexion level on the clinical condition and surgical outcomes of patients with sigmoid esophageal achalasia.

Methods

The subjects were 36 patients with sigmoid esophageal achalasia who had been observed for >1 year after surgery. The subjects were divided into sigmoid type (Sg) and advanced sigmoid type (aSg) groups based on the flexion level of the lower esophagus to compare their clinical parameters and surgical outcomes.

Results

The Sg and aSg groups included 26 (72%) and 10 subjects, respectively. There were no marked differences in the clinical parameters or surgical outcomes between the two groups. However, the clearance rate calculated using the timed barium esophagogram was lower in the aSg group than in the Sg group. No differences were found in the postoperative symptom scores between the two groups, and both reported a high level of satisfaction.

Conclusions

Although laparoscopic surgery for symptoms of sigmoid esophageal achalasia was highly successful regardless of the flexion level, the improvement in esophageal clearance was lower when the flexion level was higher.

     

胸中段食管鳞状细胞癌伴腹腔淋巴结转移及其预后的临床研究

目的 了解胸中段食管鳞状细胞癌伴腹腔淋巴结转移的方式,分析预后的影响因素.方法 对1998年1月至2003年1月接受手术治疗的368例胸中段食管鳞状细胞癌患者进行回顾性研究.本组男性289例,女性79例,年龄38～79岁,平均56岁.术前临床分期I～Ⅲ期.全部患者采用Ivor-Lewis手术(右胸及上腹部两切口)行食管大部切除加胸腹二野淋巴结清扫.全组患者平均随访时间68个月.结果 腹腔淋巴结转移58例(15.8%),其中T1-2患者占36.2%(21/58);有13.8%(8/58)的患者为跳跃性腹腔淋巴结转移,均发生在T1-2患者中.腹腔淋巴结转移患者5年生存率为10.3%,低于胸腔淋巴结转移患者的18.3%.远处腹腔淋巴结转移患者预后极差,无1例达到5年生存(0/16).COX多因素分析结果 显示,淋巴结转移数目≥5枚和远处腹腔淋巴结转移是腹腔淋巴结转移患者的独立预后因素.结论 胸中段食管癌腹腔淋巴结转移的发生率较高,应该选择有利于腹腔淋巴结广泛清扫的手术方式.腹腔淋巴结转移患者的预后不良,尤其淋巴结转移数目较多和远处淋巴结转移的患者预后更差.     

Non-sentinel lymph node metastases in breast cancer patients with metastatic sentinel nodes

BACKGROUND: Sentinel lymph node biopsy (SLNB) has been shown to be relatively accurate in axillary nodal staging in breast cancer. In more than half of the patients with metastatic sentinel lymph node (SLN), the SLN was the only lymph node involved in the axilla. Methods: A retrospective analysis was performed for those female Chinese breast cancer patients who underwent SLNB. All patients had axillary dissection after SLNB. Those patients with metastatic SLN were selected for analysis. Various tumour factors and SLN factors were analysed to study the association with residual lymph node metastasis. Results: A total of 139 SLNB was performed. The success rate of SLN localization, false negative rate and accuracy were 92%, 9% and 95%, respectively. Fifty-five patients had metastases in the SLN. In 38 patients (69%), SLN was the only lymph node involved in the axilla. Tumours <3 cm, a single metastatic SLN, presence of micro metastases and the absence of extracapsular spread in the SLN were associated with the absence of metastasis in the non-sentinel lymph nodes. Conclusion: Sentinel lymph node biopsy is accurate in the nodal staging of Chinese breast cancer patients. Several factors such as tumour <3 cm, a single metastatic SLN, micro metastases and the absence of extracapsular spread in the sentinel node(s) are useful predictors for the absence of residual disease in the axilla. With further studies and verification, these factors may prove to be important in determining which patients with metastatic SLN will require further axillary treatment. Until such information is available, axillary dissection should be performed when positive sentinel nodes are found.     

Immunohistochemistry analysis of micrometastasis in pretreatment lymph nodes from patients with esophageal cancer

BACKGROUND: With recent advances in neoadjuvant therapy in esophageal cancer, pretreatment lymph node staging has become increasingly important in stratifying patients to appropriate treatment regimens and for prognostication. Immunohistochemical analysis (IHC) using epithelial markers has been shown to identify micrometastases in histologically negative lymph nodes. We performed this study to evaluate if IHC analysis in thoracoscopic/laparoscopic (Ts/Ls) pretreatment staging lymph nodes can reveal additional diagnostic information to routine histopathology. METHODS: Specimens of 106 patients with esophageal cancer who had pretreatment Ts/Ls staging were retrospectively studied. Lymph node biopsies were obtained for IHC staining using cytokeratin (CK) of AE1/AE3. IHC staining for p53, an apoptosis protein associated with poor prognosis in esophageal cancer, was also performed. RESULTS: 331 Ts/Ls staging lymph node biopsies were collected from 106 patients. A total of 15.4% (51/331) of the lymph nodes or 34.9% (37/106) of patients were found to have metastatic deposits by routine histology. All the histologically positive lymph nodes were CK positive. Among the remaining 280 histologically negative lymph nodes, 11(3.9%) were found to have micrometastasis by CK staining. Three patients (4.3%, 3/69) were upstaged from N0 to N1. They died of early recurrences after treatment. A total of 67.6% (25/37) of the patients with histologically positive lymph node were p53 positive. No histologically negative lymph node was found to be p53 positive in this series. CONCLUSIONS: Immunohistochemical analysis for CK can detect micrometastatic involvement of lymph nodes that are missed on routine pathologic examination, and, therefore, can improve lymph node staging. Its clinical significance in esophageal cancer warrants further study.     

Histopathological features of the lymph node metastases in patients with thoracic esophageal cancer]

Histopathological features of the lymph node involvement were studied in 104 patients with thoracic esophageal cancer who underwent subtotal esophagectomy combined with extended radical lymph adenectomy in cervicothoracoabdominal region. Metastatic involvement was found in a total number of 503 lymph nodes from 73 patients by histologic examination. The mean of long and short diameter was found to be less than 5mm in 125 (24.9%) of these 503 nodes. The involved area on the section was less than one third in 149 nodes (29.6%), and was significantly smaller in mediastinal lymph nodes than those in cervical or abdominal ones. Sixty-seven (13.3%) of 503 nodes were partially invaded by micrometastasis of 1mm or less in diameter. Micrometastasis also more frequently occurred in mediastinal nodes with a statistically significant difference. Extranodal proliferation (ENP) of cancer cells was found in 106 nodes (21.1%), and extranodal lymphatic and/or blood vessel invasion (ENly, v) was also recognized in 60 nodes (11.9%). Micrometastasis and ENP with or without ENly, v were found in 24 (32.9%) and 29 (39.7%) of 73 patients with positive lymph node metastasis, respectively. Postoperative survival rate in patients with micrometastasis and/or ENP with or without ENly, v was inferior to that in patients with neither of them.     

The number of metastatic lymph nodes and the ratio between metastatic and examined lymph nodes are independent prognostic factors in esophageal cancer regardless of neoadjuvant chemoradiation or lymphadenectomy extent

OBJECTIVE: To investigate whether the number of lymph nodes metastasis (LNMs) and the ratio between metastatic and examined lymph nodes (LNs) are better prognostic factors when compared with traditional staging systems in patients with esophageal carcinoma. SUMMARY BACKGROUND DATA: The accuracy of the 6th UICC/TNM classification is suboptimal, especially when not taking into account neoadjuvant therapy and lymphadenectomy extent. METHODS: For 536 patients who underwent curative en bloc esophagectomy, in whom 51.5% (n = 276) received neoadjuvant chemoradiation, LNMs were classified according to the 6th UICC/TNM classification and systems based on the number (< or =4 and >4) or the ratio (< or =0.2 and >0.2) of LNMs. Survival of the respective stages, predictors of survival, and influence of both chemoradiation and number of examined LNs were studied. RESULTS: After a median follow-up of 50 months, the 5-year survival rates were 47% for the entire population, significantly poorer for patients with >4 LNMs (8% vs. 53%, P < 0.001) or a ratio of LNMs >0.2 (22% vs. 54%, P < 0.001). After adjustment for confounding variables, a number of LNMs >4 and a ratio of LNMs >0.2 were the only predictors of poor prognosis. The prognostic role of both the number and the ratio of LNMs was maintained whether patients received neoadjuvant chemoradiation or not. Moreover, LN ratio is shown to be more accurate for inadequately staged patients (<15 examined LNs), whereas the number of LNMs is pertinent for adequately staged patients (> or =15 examined LNs). CONCLUSION: Staging systems for esophageal cancer that use the number (< or =4 or >4) and the ratio (< or =0.2 or >0.2) of LNMs have greater prognostic importance than the current staging systems because of the good stratification of the groups and their clinical utility, taking into account neoadjuvant therapy and lymphadenectomy extent.     

胃周转移淋巴结数对胃癌患者预后评估的价值

目的寻找适用于胃癌术后患者预后比较的简单指标。方法选取1999-2005年间在复旦大学附属中山医院胃肿瘤组接受根治性手术治疗的148例患者的病例资料进行总结,分析胃周淋巴结转移情况及其与患者预后的关系。结果148例患者3年累计总生存率为62．8％,生存率随胃周转移淋巴结数增加而下降。当胃周转移淋巴结数超过6枚时,3年生存率降至15．4％,与全组3年总生存率比较,差异有统计学意义（P〈0．01）。胃周转移淋巴结数与总阳性淋巴结数存在线性关系（r=0．94,P〈0．01）,但与总切除淋巴结数不存在线性关系（r=0．18,P=0．2）。结论胃周转移淋巴结是一个简单有效判断胃癌术后患者预后的指标。胃周转移淋巴结对淋巴结切除技术要求低,可用于比较不同地区间胃癌术后患者的预后。     

Long-term outcome of surgical treatment of patients with esophageal cancer

Under study were the results of surgical treatment of 185 patients with esophageal carcinoma. One-year survival was 75.4%, 2-year survival was 49.6%, 3-year--43.4%, and 4-year survival--33.3%. Among the patients with tumors with the invasion degree T1, T2, T3 and having no metastases to the regional lymph nodes the resection of the esophagus in combination with the extended lympho dissection resulted in 4-year survival in more than 50% of the patients operated upon. In patients with tumors T3N1, T4N1 and especially with the simultaneous involvement of several lymph collectors the 4-year survival was 21.4%. The operative intervention at this stage of the disease should be considered as a palliative means in the greater part of the patients.