共查询到20条相似文献,搜索用时 31 毫秒
1.
de Manzoni G Di Leo A Roviello F Marrelli D Giacopuzzi S Minicozzi AM Verlato G 《Annals of surgical oncology》2011,18(8):2273-2280
Background
This study was designed to identify pathological predictors of para-aortic nodal invasion in advanced gastric cancer. 相似文献2.
Murakami Y Uemura K Sudo T Hashimoto Y Nakashima A Kondo N Sakabe R Kobayashi H Sueda T 《World journal of surgery》2011,35(5):1085-1093
Background
Para-aortic nodal dissection in patients with biliary carcinoma has not been performed routinely worldwide. Therefore, the prognostic impact of para-aortic lymph node metastasis in biliary carcinoma has not yet been evaluated. The aim of this study was to clarify the prognostic impact of para-aortic lymph node metastasis in biliary carcinoma. 相似文献3.
Yoshiaki Murakami Kenichiro Uemura Takeshi Sudo Yasushi Hashimoto Yoshio Yuasa Taijiro Sueda 《World journal of surgery》2010,34(8):1900-1907
Background
The aim of the present study was to clarify the prognostic impact of para-aortic lymph node metastasis in pancreatic ductal adenocarcinoma. 相似文献4.
Marrelli D Mazzei MA Pedrazzani C Di Martino M Vindigni C Corso G Morelli E Volterrani L Roviello F 《Annals of surgical oncology》2011,18(8):2265-2272
Background
The purpose of this study is to analyze the diagnostic accuracy of MSCT in the identification of para-aortic lymph node metastases from gastric cancer. 相似文献5.
Pulitanò C Bodingbauer M Aldrighetti L Choti MA Castillo F Schulick RD Gruenberger T Pawlik TM 《Annals of surgical oncology》2012,19(2):435-442
Background
For patients with colorectal liver metastasis (CLM), the presence of concomitant perihepatic/para-aortic lymph node metastasis (LNM) is considered a contraindication to liver resection. We sought to determine the benefits of liver resection among patients with CLM + LNM by examining long-term outcomes among a large cohort of patients. 相似文献6.
Jeong-Yeol Park Dae-Yeon Kim Jong-Hyeok Kim Yong-Man Kim Young-Tak Kim Joo-Hyun Nam 《Annals of surgical oncology》2010,17(3):861-868
Aims
To determine the incidence of lymph node (LN) metastasis in patients with apparently early carcinosarcoma of the uterus, to analyze the clinicopathologic factors associated with LN metastasis, and to evaluate the role of pelvic and/or para-aortic lymphadenectomy in treatment of such conditions. 相似文献7.
Masanori Tokunaga Shigekazu Ohyama Naoki Hiki Tetsu Fukunaga Susumu Aikou Toshiharu Yamaguchi 《Annals of surgical oncology》2010,17(8):2031-2036
Background
The prognosis of patients with gastric cancer and para-aortic lymph node (PALN) metastasis is poor. Recent Japanese randomized trials concluded that prophylactic PALN dissection is not effective for curable advanced gastric cancer. However, the value of curative resection in patients with pathologically positive PALN is not determined yet. 相似文献8.
Tong SY Lee JM Lee JK Kim JW Cho CH Kim SM Park SY Park CY Kim KT 《Annals of surgical oncology》2011,18(5):1425-1430
Purpose
The objective of this study was to assess whether para-aortic lymphadenectomy has therapeutic efficacy for patients with early-stage endometrioid uterine cancer who underwent systematic pelvic lymphadenectomy.Methods
The authors retrospectively reviewed the medical records and pathological findings of 547 patients with histologically proven FIGO stage I-II endometrioid uterine cancer, based on comprehensive surgical staging, including pelvic with or without para-aortic lymphadenectomy.Results
Among 547 patients, 330 patients had systematic pelvic lymphadenectomy only, and 217 had systematic pelvic with para-aortic lymphadenectomy. There were no significant differences in histopathological factors in the high-risk group, even though deep myometrial invasion (p = 0.02) and lymphvascular space invasion (p = 0.01) were more common in patients who underwent systematic pelvic with para-aortic lymphadenectomy in all study populations. Within a median follow-up of 31 (range, 5–120) months, there was no significant difference in overall survival between the pelvic lymphadenectomy only and pelvic with para-aortic lymphadenectomy groups in all populations (p = 0.77), even in high-risk patients (p = 0.82). Upon multivariate analysis, patients with lymphvascular space invasion had significantly worse overall survival (odds ratio (OR) = 7.38; 95% confidence interval (CI) = 1.86–29.23; p = 0.004).Conclusions
Although a prospective, randomized study needs to be performed for confirmation, our data suggest that the therapeutic benefit of para-aortic lymphadenectomy is uncertain in stage I and II endometrioid uterine corpus cancer, even in patients at high-risk for recurrence. 相似文献9.
Suk-Joon Chang MD PhD Tae Wook Kong MD Woo Young Kim MD Seung-Chul Yoo MD PhD Jong-Hyuck Yoon MD Ki-Hong Chang MD PhD Hee-Sug Ryu MD PhD 《Annals of surgical oncology》2011,18(1):58-64
Background
The purpose of this study was to investigate various pathologic risk factors associated with para-aortic lymph node metastasis (LNM) in surgically staged patients with endometrial cancer.Materials and Methods
We performed a retrospective analysis of 203 consecutive patients with endometrial cancer who were surgically staged from 2000 to 2009. The association among the various pathologic variables for para-aortic LNM was determined with univariate and multivariate analyses.Results
Of 203 patients, 29 patients (14.3%) had LNM. Also, 10 patients (4.9%) had only pelvic LNM, 14 (6.9%) had both pelvic and para-aortic LNM, and 5 (2.5%) had para-aortic LNM without pelvic LN involvements. Histologic type (P = .001), tumor grade (P < .001), tumor size (P = .003), depth of myometrial invasion (P < .001), cervical invasion (P < .001), parametrial invasion (P = .002), lymph-vascular space invasion (LVSI) (P < .001), serosal/adnexal invasion (P < .001), positive cytology (P = .002), peritoneal seeding (P < .001), and pelvic LNM (P < .001) were significant pathologic factors for para-aortic LNM. On multivariate analysis, cervical invasion (P = .032), LVSI (P = .018), and positive pelvic LNs (P = .002) were independent factors for para-aortic LNM. With regard to isolated para-aortic LNM, tumor grade (P = .017) and LVSI (P = .002) were significant factors for LN involvements. On multivariate analysis, LVSI (P = .004) was the only significant independent factor.Conclusions
LVSI correlates significantly with the risk of isolated para-aortic LNM in endometrial cancer patients. 相似文献10.
Tetsuji Odagiri MD Hidemichi Watari MD PhD Tatsuya Kato MD Takashi Mitamura MD PhD Masayoshi Hosaka MD PhD Satoko Sudo MD PhD Mahito Takeda MD PhD Noriko Kobayashi MD PhD Peixin Dong MD PhD Yukiharu Todo MD PhD Masataka Kudo MD PhD Noriaki Sakuragi MD PhD 《Annals of surgical oncology》2014,21(8):2755-2761
Purpose
The aim of this study was to demonstrate the precise mapping of lymph node metastasis (LNM) sites in endometrial cancer.Methods
A total of 266 patients who underwent primary radical surgery including systematic pelvic and para-aortic lymphadenectomy for endometrial cancer from 1993 to 2010 were enrolled in this study. We removed lymph nodes from the femoral ring to the para-aortic node up to the level of renal veins. We analyzed the distribution of positive-node sites according to their anatomical location.Results
Overall, 42 of 266 patients (15.8 %) showed LNM. The median number of nodes harvested was 62.5 (range 40–119) in pelvic nodes (PLN), and 20 (range 3–47) in para-aortic nodes (PAN). Among 42 cases with positive-nodes, 16 cases (38.1 %) showed positive PLN alone, 7 cases (16.7 %) in PAN alone, and 19 cases (45.2 %) in both PLN and PAN. The most prevalent site of positive-nodes was PAN (9.8 %) followed by obturator nodes (9.4 %), internal iliac nodes (7.1 %), and common iliac nodes (5.6 %). Six of 19 cases (31.6 %) of positive PAN above the inferior mesenteric artery (IMA) showed negative PAN below IMA. Metastasis to the deep inguinal nodes was found to be extremely rare (0.38 %). Single-site LNM was the most frequently observed in obturator nodes, followed by PAN above IMA.Conclusion
Routine resection of deep inguinal nodes is not recommended, whereas para-aortic lymphadenectomy should be extended up to the level of renal veins for endometrial cancer. 相似文献11.
Antonio Gil-Moreno MD Silvia Franco-Camps MD Silvia Cabrera MD Assumpció Pérez-Benavente MD Xavier Martínez-Gómez MD Angel Garcia MD Jordi Xercavins MD 《Annals of surgical oncology》2011,18(2):482-489
Background
To assess the safety, feasibility, and impact on survival of extraperitoneal para-aortic lymphadenectomy in the staging of patients with bulky or locally advanced cervical cancer.Materials and Methods
Between August 2001 and October 2009, 87 consecutive patients (median age 51 years) with bulky or locally advanced cervical cancer underwent extraperitoneal laparoscopic infrarenal aortic and common iliac dissection as a pretherapeutic staging procedure. Data on pathologic findings, details of surgery, postoperative complications, and disease status at follow-up were collected.Results
The median operating time was 150 min (range 60–255 min). The mean (± standard deviation) para-aortic nodal yield was 15.5 ± 8.1 (range 4–62). In none of the patients, conversion to the transperitoneal approach or laparotomy was necessary. Histological examination revealed metastasis in 13 patients (macroscopic disease 10, microscopic disease 3). After a median follow-up of 33.4 months (range 13.3–65.9 months), 73.6% of patients were free of disease and 1.1% were alive with disease, 19.5% died from cervical cancer, and 3.3% died from other causes. After a follow-up of 3 years, no deaths or recurrences were documented, with an overall survival rate of 74.8% (95% CI 62.8%–83.4%) and disease-free survival of 86% (95% CI 74.7%–92.5%). There were no significant differences in overall survival and disease-free survival between patients with positive and negative para-aortic lymph nodes.Conclusion
The extraperitoneal laparoscopic para-aortic lymphadenectomy for pretherapeutic surgical staging in cervical cancer is a safe and feasible procedure that should be considered as a tool to identify lymph node positive patients who require extended-field radiation and/or chemotherapy. 相似文献12.
Sun Jin Sym MD Heung Moon Chang PhD Min-Hee Ryu PhD Jae-Lyun Lee PhD Tae Won Kim PhD Jeong Hwan Yook PhD Sung Tae Oh PhD Byung Sik Kim PhD Yoon-Koo Kang PhD 《Annals of surgical oncology》2010,17(4):1024-1032
Background
This phase II study was conducted to evaluate the efficacy of neoadjuvant chemotherapy with docetaxel, cisplatin and capecitabine (DXP) in patients with unresectable locally advanced and/or intra-abdominal metastatic gastric cancers.Methods
Patients with advanced gastric cancer (AGC), clinically unresectable because of local invasion or limited intra-abdominal metastasis in para-aortic lymph nodes and/or the peritoneum based on multidetector row computed tomography, were enrolled. DXP consisted of docetaxel 60 mg/m2 i.v. and cisplatin 60 mg/m2 i.v. on day 1, and capecitabine 937.5 mg/m2 twice daily p.o. on days 1–14 every 21 days. Surgery was performed after 4–6 cycles of DXP.Results
Thirty-six (74%) of the 49 patients enrolled underwent surgery, and 31 (63%) had an R0 resection. R0 resection was possible in 15 of 21 patients (71%) with unresectable locally advanced lesions, 12 of 17 patients (70%) with para-aortic lymph node metastasis but only 4 of 11 patients (36%) with peritoneal metastasis. Grade 3/4 toxicities included neutropenia (69%), febrile neutropenia (4%) and hand–foot syndrome (8%).Conclusions
Neoadjuvant DXP may offer a reasonable chance of curative surgery in AGC patients with unresectable locally advanced or para-aortic lymph node metastasis. 相似文献13.
Antonino Ditto MD Fabio Martinelli MD Salvatore Lo Vullo Claudio Reato MD Eugenio Solima MD Marialuisa Carcangiu MD Edward Haeusler MD Luigi Mariani MD Domenica Lorusso MD Francesco Raspagliesi MD 《Annals of surgical oncology》2013,20(12):3948-3954
Purpose
To investigate whether the total number of removed lymph nodes (LNs) and the number of metastatic LNs would prove to be independent prognostic factors for survival in patients with cervical cancer (CC).Methods
Data from patients with CC who underwent radical surgery between March 1980 and September 2009 were reviewed. A total of 526 patients were included in the statistical analysis. Full pathologic evaluation was performed. The total number of examined LNs and their histopathological status were analyzed for their prognostic effect on survival by means of multivariable Cox proportional hazard regression models.Results
The median number (interquartile range) of total, pelvic, and para-aortic nodes removed was 37 (29–47), 34 (27–42), and 19 (14–24), respectively. Positive pelvic nodes were found in 102 of 526 (19 %) patients. All 8 patients with para-aortic metastases had also pelvic node metastases. At multivariable analysis, vaginal involvement, type of lymphadenectomy and LN status all significantly negatively affected disease-free survival and overall survival, whereas the number of total LNs removed did not affect survival.Conclusions
LN metastasis and number of LN metastases confer an independent risk for worse survival in patients with CC. Pelvic lymphadenectomy is important for staging and regional disease control when LNs are involved. If a standardized complete lymphadenectomy is performed, the number of LNs is not a significant factor per se. 相似文献14.
Ryota Higuchi MD PhD Takehiro Ota MD PhD Tatsuo Araida MD PhD Hideki Kajiyama MD Takehisa Yazawa MD PhD Toru Furukawa MD PhD Tatsuya Yoshikawa MD PhD Ken Takasaki MD PhD Masakazu Yamamoto MD PhD 《Annals of surgical oncology》2014,21(13):4308-4316
Purpose
The aim was to evaluate prognostic factors and factors associated with the resectability of advanced gallbladder cancer (GBC).Methods
This was a single-institution retrospective review of 274 consecutive surgically-treated cases of advanced GBC (excluding incidental GBC and early GBC). Univariate and multivariate analysis were performed to assess prognostic variables. R0 resection and survival rates were investigated for each local extension factor.Results
Long-term survival was uncommon among patients with multiple liver metastases (H2–3: n = 22; 2-year survival, 0 %), dissemination (P1–3: n = 16; 3-year survival, 0 %), invasion through the hepatoduodenal ligament (Binf3: n = 45; 5-year survival, 4.6 %), or group 3 lymph node (LN) metastasis including of the para-aortic LN (N3: n = 52; 13.7 %). Long-term survival rates did not differ significantly between patients who did and did not undergo bile duct resection or pancreaticoduodenectomy. Survival did not differ significantly according to the type of hepatectomy performed.Conclusion
Surgery may not be indicated for patients with multiple liver metastasis, dissemination, Binf3, or visible para-aortic LN metastasis. Furthermore, it is important to achieve R0 surgery in cases of GBC. 相似文献15.
Hiroaki Nagano Mitsue Muraoka Koichiro Takagi 《International journal of surgery case reports》2014,5(7):412-415
INTRODUCTION
Occasionally, lymph node metastases represent the only component at the time of recurrence of ovarian cancer. Here we report the case of a 78-year-old Japanese female who underwent successful surgery for recurrent ovarian cancer with multiple lymph node metastases.PRESENTATION OF CASE
The patient was referred to our institution with recurrent disease accompanied by chemoresistant multiple retroperitoneal lymph node metastases five years after the initial therapy for stage IIIc serous adenocarcinoma of the ovary. Positron emission tomography/computed tomography (PET/CT) revealed the involvement of two para-aortic nodes and two pelvic nodes, with no other positive site. The patient underwent systematic para-aortic and pelvic lymphadenectomy, and the metastatic nodes were completely resected. Histopathological examination revealed metastatic high-grade adenocarcinoma in four of 63 dissected lymph node specimens. The patient has been in clinical remission for over four years without any further additional therapies.DISCUSSION
In our case, the metastatic nodes predicted by PET/CT completely corresponded to the actual metastatic nodes; however, PET/CT often fails to identify microscopic disease in pathological positive nodes. We cannot reliably predict whether lymph node metastasis will persist in the limited range. Therefore, systematic lymphadenectomy with therapeutic intent should be performed, although it does not always mean that we remove all cancer cells.CONCLUSION
The findings from this case suggest that, even if used as secondary cytoreductive surgery in the context of a recurrent disease, systematic aortic and pelvic node dissection might sometimes contribute to the control if not cure of ovarian cancer. 相似文献16.
Dae G. Hong Nae Y. Park Gun O. Chong Young L. Cho Il S. Park Yoon S. Lee Dae Hyung Lee 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2012,16(2):229-235
Background and Objectives:
This study aimed to evaluate the safety, feasibility, and clinical outcomes of laparoscopic transperitoneal infrarenal para-aortic lymphadenectomy in patients with FIGO stage IB1-IIB cervical carcinoma.Methods:
Between August 1999 and April 2009, we performed 59 laparoscopic transperitoneal lymphadenectomies; specifically, 12 procedures were performed up to the level of the left renal vessels, and 47 procedures were performed up to the level of the inferior mesenteric artery. We retrospectively analyzed the pathology reports and clinical data and compared the 2 groups. The data were analyzed with a nonparametric Mann-Whitney test, Kaplan-Meier log-rank test, and Pearson''s correlation analysis.Results:
The 2 groups did not significantly differ with respect to histologic type (P=.093), clinical stage (P=.053), tumor size (P=.383), time interval to start adjuvant therapy postoperatively (P=.064), and type of adjuvant therapy (P=.407). The blood loss (P=.131), operative time (P=.200), mean hospital stay (P=.417), and postoperative self-voiding (P=.306) did not significantly differ between the groups, with the exception of the number of harvested lymph nodes (P=.001). The disease-free survival was better in the group that underwent infrarenal para-aortic lymphadenectomy than the group that did not (P=.017); however, the 2 groups did not differ with respect to overall survival (P=.115).Conclusion:
We suggest that laparoscopic transperitoneal infrarenal lymphadenectomy for cervical cancer is feasible and safe. The rate of positive lymph nodes in infrarenal lymphadenectomy is very rare in patients with locally advanced cervical carcinoma. Infrarenal lymphadenectomy in patients with cervical cancer did not provide additional survival benefits in this study. 相似文献17.
Tatsuo Matsuda Hiroya Takeuchi Shinichi Tsuwano Rieko Nakamura Tsunehiro Takahashi Norihito Wada Hirofumi Kawakubo Yoshiro Saikawa Tai Omori Yuko Kitagawa 《General thoracic and cardiovascular surgery》2014,62(9):560-566
Objectives
Esophagogastric junction carcinoma incidence is increasing worldwide. However, surgical strategies for this cancer remain controversial. This study aimed to clarify the optimal surgical strategy for esophagogastric junction carcinoma.Methods
We retrospectively reviewed a database of 68 consecutive patients with esophagogastric junction carcinoma [Japanese classification of gastric carcinoma (Nishi’s definition): adenocarcinoma, N = 53; squamous cell carcinoma, N = 15] who underwent curative surgical resection at Keio University Hospital between January 2000 and September 2008.Results
In both adenocarcinoma and squamous cell carcinoma, most lymph node metastases were located in the lesser curvature area. Mediastinal lymph node metastasis was observed in 4 patients (7.5 %) with adenocarcinoma and 7 patients (46.7 %) with squamous cell carcinoma. No patient presented with lymph node metastases in the pyloric region. The therapeutic value of extended lymph node dissection was 0, except for lymph node station numbers 1, 2, 3, 4sa, 7, and 110. Extended lymph node dissection in the lesser curvature area showed a high therapeutic value. The para-aortic lymph node was the most frequent nodal recurrence site. All patients with tumor centers located below the esophagogastric junction (N = 37) did not develop mediastinal lymph node metastasis or recurrence.Conclusions
Proximal gastrectomy through a transhiatal approach may be the optimal surgical strategy for esophagogastric carcinoma. Mediastinal lymph node dissection through a thoracic approach seems unnecessary, particularly when the tumor center is located below the esophagogastric junction. To confirm the necessity of para-aortic nodal dissection, further studies are required. 相似文献18.
Antonino Ditto MD Fabio Martinelli MD Claudio Reato MD Shigeky Kusamura MD Eugenio Solima MD Rosanna Fontanelli MD Edward Haeusler MD Francesco Raspagliesi MD 《Annals of surgical oncology》2012,19(12):3849-3855
Background
Lymphadenectomy is important in the surgical treatment of apparent early epithelial ovarian cancers (eEOC); however, its extent is not well defined. We evaluated the role of systematic lymphadenectomy, the risk factors related with lymph node metastases, the implications, and the morbidity of comprehensive surgical staging.Methods
We prospectively recruited 124 patients diagnosed with apparent eEOC [International Federation of Gynecology and Obstetrics (FIGO) stage I and II] between January 2003 and January 2011. Demographics, surgical procedures, morbidities, pathologic findings, and correlations with lymph node metastases were assessed.Results
A total of 111 patients underwent complete surgical staging, including lymphadenectomy, and were therefore analyzed. A median of 23 pelvic and 20 para-aortic nodes were removed. Node metastases were found in 15 patients (13.5?%). The para-aortic region was involved in 13 (86.6?%) of 15 cases. At univariate analysis, age, menopause, FIGO stage, grading, and laterality were found to be significant factors for lymph node metastases, while CA125 of >35?U/ml and positive cytology were not. No lymph node metastases were found in mucinous histotypes. At multivariate analysis, only bilaterality (p?=?0.018) and menopause (p?=?0.032) maintained a statistically significant association with lymph node metastases. Lymphadenectomy-related complications (lymphocyst formation and lymphorrhea) were found in 14.4?% patients.Conclusions
The data of this prospective study demonstrate the prognostic value of lymphadenectomy in eEOC. Menopause, age, bilaterality, histology, and tumor grade are identifiable factors that can help the surgeon decide whether to perform comprehensive surgical staging with lymph node dissection. These parameters may be used in planning subsequent treatment. 相似文献19.
Tatsuo Matsuda Yukinori Kurokawa Takaki Yoshikawa Kentaro Kishi Kazunari Misawa Masaki Ohi Shinji Mine Naoki Hiki Hiroya Takeuchi 《World journal of surgery》2016,40(7):1672-1679
Background
The incidence of esophagogastric junction (EGJ) carcinoma is increasing, but its optimal surgical management remains controversial.Methods
We retrospectively reviewed the database of 400 patients with Siewert type II EGJ carcinoma who were treated surgically at 7 institutions between March 1986 and October 2010. We examined the clinicopathological characteristics, prognostic factors, and risk factors associated with each recurrence pattern.Results
The 5-year overall survival rate of all patients with Siewert type II EGJ carcinoma was 58.4 %. Multivariate analysis showed that T and N stages were independent prognostic factors. We also found that the incidence of lower mediastinal lymph node metastasis (17.7 %) and para-aortic lymph node metastasis (16.1 %) was relatively high. In addition, the para-aortic lymph nodes (N = 39, 9.8 %) were the most frequent node recurrence site, followed by the mediastinal lymph nodes (N = 23, 5.8 %). Lung recurrence was more common than was peritoneal recurrence. Considering each type of recurrence, multivariate analysis showed that the differentiated type was associated with a higher risk of lung recurrence than was the undifferentiated type, and N stage (pN2–3) and positive venous invasion were independent risk factors for liver recurrence.Conclusions
This study is one of the largest retrospective studies to evaluate patients with Siewert type II EGJ carcinoma. Para-aortic and mediastinal lymph node metastasis and recurrence rates were relatively high. During the postoperative follow-up of patients with differentiated Siewert type II EGJ carcinoma, patients should be monitored for lung recurrence more closely than that for peritoneal recurrence.20.
Hiroshi Yabusaki Atsushi Nashimoto Atsushi Matsuki Masaki Aizawa 《Surgery today》2014,44(8):1522-1528