Extended lymphadenectomy in stomach cancer]

The results of surgical treatment in 120 patients with cancer of the stomach have been analyzed. Metastatic involvement in all groups of lymphatic nodes was revealed in 68.3% cases, retroperitoneal metastases were detected in 46 patients (38.3%). 38 subtotal resections of the stomach and 82 gastrectomies with retroperitoneal lymphadenectomy R2 and R3 were performed. Esophagojejunoanastomosis end-to-end with a loop excluded by Roux was applied in 110 patients and esophagoduodenoanastomosis--in 10 patients. Insufficiency of esophagointestinal anastomosis was revealed in 3 patients. The rate of complications was 29.2%, lethality--8.3%. High rate of postoperative complications and lethality were explained by initially severe conditions of the patients (61%) and by complicated forms of gastric cancer in 6 patients. Improvement of early results of surgical interventions lies in the usage of antibacterial prophylaxis, preventive intravenous introductions of 5-fluorouracil, adequate drainage of the abdominal cavity, careful preparation and ligation in the course of the operation.     

Appropriate extent of lymphadenectomy in esophageal cancer]

Because of the high frequency and widespread distribution of lymph node metastasis in esophageal cancer, three-field dissection was introduced in the early 1980s. Although improvement in the long-term survival rate of patients who undergo three-field dissection has been reported, the clinical significance of cervical lymphadenectomy is still controversial because the effect of improved upper-mediastinal lymphadenectomy in these patients cannot be excluded. Recently, the sentinel node (SN) concept has been validated in gastrointestinal cancers including esophageal cancer using the radio-guided method. Aberrant drainage routes from the primary lesion have frequently been observed in esophageal cancer and are detectable by radio-guided SN mapping. SN navigation is useful to identify SNs as the functional first basin to evaluate the regional lymph node status and to determine the indications for extensive lymphadenectomy in patients with esophageal cancer. Individualized surgical management of patients with esophageal cancer is essential to improve the quality of life of patients and long-term results.     

Laparoscopic pelvic lymphadenectomy in patients with localized prostate cancer]

Laparoscopic pelvic lymphadenectomy is a newly developed technique of lymph node dissection in patients with malignancy of the pelvic organs. Three patients with localized prostatic cancer underwent laparoscopic pelvic lymphadenectomy. The patients were 77 years old with stage C disease, 73 with stage B1, and 65 with stage A2. Five to ten lymph nodes were removed from each patient after laparoscopic procedures lasting 220 to 270 minutes. There were no complications during the procedures and their convalescence was uneventful. All lymph nodes were negative by pathological examination and a radical retropubic prostatectomy was done 2 weeks after the lymphadenectomy in two patients. The other patient was treated with external radiotherapy and bilateral orchiectomy. Patients with stage C cancer, a high serum level of prostate specific antigen or a high grade tumor are the best candidates for this less invasive staging procedure. The disadvantage of this procedure is long operation time and complications due to CO2 pneumoperitoneum.     

Expediency of preventive lymphadenectomy in patients with skin melanoma]

On the basis of the results of treatment of 87 patients with skin melanoma, the expediency of lymphadenectomy performance irrespective of the fact whether the regional lymph nodes were, or were not palpated was substantiated. Performance of this operation permitted 3-fold reduction of lethality.     

Video-assisted mediastinoscopic lymphadenectomy and transcervical extended mediastinal lymphadenectomy

This article describes in detail the operative technique of the new surgical methods, video-assisted mediastinoscopic lymphadenectomy (VAMLA) and transcervical extended mediastinal lymphadenectomy (TEMLA). Both techniques enable the removal of the mediastinal nodes with the surrounding fatty tissue. VAMLA and TEMLA have very high diagnostic yield and can be combined with minimally invasive video-assisted lobectomy.     

Results of radical nephrectomy associated with regional lymphadenectomy for renal cell carcinoma]

Between January, 1975 and December, 1989, 86 patients with renal cell carcinoma received radical nephrectomy associated with lymphadenectomy at our institutions. Pathological examination revealed lymph node metastasis in 15 patients (17.4%). The incidence of lymph node metastasis increased in accordance with the aggravation of tumor stage (p less than 0.01) and grade (p less than 0.05). Patients with a rapidly growing tumor showed higher incidence of lymph node metastasis than patients with a slow growing tumor (p less than 0.01). Regional lymph node metastases were found in 3 of the 41 patients with a slow growing tumor. Since these 3 patients are surviving with no evidence of disease for 38.7 months on average, the regional lymphadenectomy was considered to have been effective for their survival. Nine of the 25 patients with a rapid growing tumor had progressive lymph node metastasis. Four of them had apparent tumor thrombi as well as lymph node metastasis, and 2 of them had distant metastasis. These patients showed poor prognosis even after operation. Lymphadenectomy was of no value to the patients with apparent tumor thrombi and/or distant metastasis.     

Nerve-sparing retroperitoneal lymphadenectomy

Surgery for retroperitoneal nodal metastases of testicular germ-cell tumors has evolved considerably since its inception. Minimizing injury to sympathetic nerves has involved their exclusion from resection boundaries and/or "nerve sparing," by identifying and preserving nerves within the resection field. These measures improve long-term procedure-related morbidity with equivalent rates of cancer control. We believe that nerve-sparing techniques are the standard of care and enforce good principles of surgery by demanding attention to anatomy and exposure. Experience with this procedure, knowledge of retroperitoneal anatomy, and thoughtful clinical and surgical decision making are imperative to achieving acceptable results. It behooves urologic oncologists to offer patients maximal therapeutic benefit combined with minimal morbidity and that retroperitoneal lymphadenectomy should be nerve sparing by definition.     

Radical ilioinguinal lymphadenectomy

Radical ilioinguinal lymphadenectomy remains the mainstay of treatment for certain genitourinary carcinomas either with the propensity for or with clinical evidence of metastases to the inguinal-pelvic region. The most frequent indication for this procedure in urologic practice is carcinoma of the penis, followed by carcinoma of the urethra, scrotum, and testis with scrotal invasion. This article reviews the anatomy of the inguinal and iliac region and presents a detailed discussion of the surgical technique.     

Nerve sparing retroperitoneal lymphadenectomy with intraoperative electrostimulation in patients with nonseminomatous testicular tumors]

Thirteen patients with nonseminomatous testicular germ cell tumours underwent nerve-sparing retroperitoneal lymphadenectomy (RLA) with prospective isolation and preservation of postganglionic sympathetic nerve fibres. In all ten patients with pathological stage I in whom a unilateral nerve-sparing RLA was performed, ejaculation was preserved. In two of three patients with pathological stage IIa who underwent a bilateral RLA with a nerve-sparing technique on one side, ejaculation was also preserved. In nine patients intraoperative electrostimulation of isolated sympathetic nerve fibres was performed employing Brindley's stimulation device. The result was an immediate and reproducible ejaculation in seven patients. Thus electrostimulation of sympathetic nerves may be a useful intraoperative test for the identification of the nerve fibres that need to be protected for ejaculation. Nerve-sparing RLA seems to be superior to modified (unilateral) RLA with regard to preservation of ejaculation.     

Early complications of combined pelvic lymphadenectomy and radical prostatectomy versus lymphadenectomy alone

A comparison of the early morbidity of pelvic lymphadenectomy plus radical prostatectomy versus lymphadenectomy alone is reported. Fifty-one patients underwent the combined procedure; 26 had lymphadenectomy alone. Incidence of early complications was 35% in patients undergoing prostatectomy and node dissection and 27% in patients undergoing lymph node dissection only, a difference which is not statistically significant. Thrombophlebitis and pulmonary embolus occurred after the combined procedure. There was one postoperative death in the combined surgery group. The results of this study suggest that lymph node dissection may be performed at the time of radical prostatectomy rather than as a staging procedure, and emphasize the importance of pelvic lymph node dissection in the evaluation and treatment of clinically localized prostate cancer.     

Electroejaculation following retroperitoneal lymphadenectomy

Transrectal electroejaculation was performed in 24 men who were anejaculatory from retroperitoneal lymphadenectomy. Of the men 23 had undergone retroperitoneal lymphadenectomy because of testis cancer. Seminal emission was achieved in all patients. In 21 patients greater than 10 x 10(6) progressively motile sperm with normal morphology were obtained. The average sperm count and motilities obtained were 289 x 10(6) and 18%, respectively, for the antegrade fractions, and 2,051 x 10(6) and 13%, respectively, for the retrograde fractions. Of the 3 azoospermic failures 2 had chemotherapy-induced testicular damage and 1 had carcinoma in situ of the remaining testis. A total of 19 couples underwent artificial insemination with electroejaculated sperm. There were 7 pregnancies achieved in 74 insemination cycles (36.8% of the couples conceived for a 9% cycle fecundity). Routine semen parameters could not predict which couples would be successful in achieving pregnancy. There were 2 first trimester spontaneous abortions. Five healthy children have been born. Electroejaculation is an excellent treatment for anejaculation that persists following retroperitoneal lymph node dissection.     

Radical trachelectomy with lymphadenectomy

Radical trachelectomy was described for the first time by Dargent in 1987 as an alternative to the traditional radical hysterectomy; it led to a changed procedure in therapy for early cervical cancer in young women who want to preserve their fertility. With this technique it is possible to remove the uterine cervix and parametrius and at the same time preserve the upper part of the cervical canal and uterus. Only a low-risk subset of young patients with early cancer of the cervix are considered eligible for this treatment; to select them histological and clinical staging of the lesion are the most important criteria. We describe the cases of three patients treated with radical trachelectomy between June 1997 and March 1998 in our Institute, reporting in detail the surgical procedure and the results.