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31.
淋巴结清扫数目对无淋巴结转移胃癌患者预后的影响 总被引:1,自引:0,他引:1
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. 相似文献
32.
胃癌10和11组淋巴结转移及其清扫 总被引:5,自引:0,他引:5
目的:研究胃癌脾门淋巴结(No.10)和脾动脉周围淋巴结(No.11)转移规律,进一步探讨No.10和11清扫的必要性和方法。方法:1991年-2000年132例行全胃切除,D2以上淋巴结清扫的胃癌患者,回顾性研究临床病理资料,包括性别、年龄、肿瘤部位、大小、浸润深度、病理类型、其他淋巴结转移等对No.10和11转移的影响,比较全胃切除和全胃联合脏器切除的并发症发生率。结果:胃癌具有较高的No.10或11淋巴结转移率(18.9%),Logistic回归分析表明,胃癌部位、病理类型、浸润深度和大小弯淋巴结转移五项临床病理指标影响No.10和U转移率。联合脏器切除的并发症发生率(32%)明显高于单纯全胃切除(11.2%),联合肢体尾切除增加肠下脓肿发生率,而脾切除并不增加全胃切除的危险性。结论:No.10和11在胃癌有较高的转移率和特定的转移规律,预防性和治疗性的清扫实属必要,联合左侧肢体尾加脾切除增加手术危险性,应严格掌握的适应证。而保留胰腺,切除脾血管和脾清扫No.10.和ll淋巴结合理可靠。 相似文献
33.
J P Geisler G C Linnemeier K J Manahan 《International journal of gynaecology and obstetrics》2007,98(1):39-43
BACKGROUND: The purpose is to determine the rate of lymph node metastases in women with endometrioid adenocarcinoma of the endometrium (EAE) undergoing systematic lymphadenectomy. METHODS: Patients (349) underwent a complete pelvic and para-aortic lymphadenectomy from caudal to the median circumflex to the level of the renal vessels. RESULTS: Grade 1 tumors accounted for 32.7% of the tumors and 31.0% of the positive nodes, grade 2 accounted for 47.3% of the tumors (37.9% of positive nodes), and grade 3 accounted for 20.1% of the tumors and 31.0% of the positive nodes (P>0.05). Positive nodes were found in 15.8% of grade 1 tumors, 13.3% of grade 2 tumors and 25.7% of grade 3 tumors (P>0.05). Isolated para-aortic involvement without pelvic nodal involvement occurred in 29% of patients with positive nodes. CONCLUSIONS: When complete lymphadenectomies are performed in EAE, positive lymph nodes (including isolated para-aortic lymph nodes) are common in all grades. 相似文献
34.
Thenappan Chandrasekar Hanan Goldberg Zachary Klaassen Rashid K. Sayyid Robert J. Hamilton Neil E. Fleshner Girish S. Kulkarni 《Urologic oncology》2018,36(1):13.e11-13.e18
Background
To examine usage trends, guideline adherence, and survival data for patients undergoing lymphadenectomy (LND) at the time of radical prostatectomy (RP) for Gleason 7 prostate cancer (PCa).Methods
The SEER database was queried for all patients with nonmetastatic biopsy Gleason 7 PCa from 2004 to 2013. Distribution and trends of LND were analyzed. The Memorial-Sloan Kettering Cancer Center nomogram was applied to stratify patients based on risk of nodal disease at time of RP (<5% risk or ≥5% risk). Analyses were performed to determine covariates associated with LND receipt at time of RP and cancer-specific mortality (CSM).Results
A total of 78,641 patients with either G34 or G43 PCa underwent RP (59,194 and 19,447, respectively). Of these patients, 61.2% of G34 and 73.5% of G43 patients underwent LND. During this 10-year period, the proportion of G43 patients undergoing LND remained relatively stable, whereas the proportion of G34 patients undergoing LND ranged between 55.9% and 67.9%. Regional differences were a predictor of LND receipt regardless of risk stratification, but did not translate to higher risk of CSM. Receipt of LND was not predictive of improved CSM in any of the cohorts analyzed.Conclusions
The role of LND for Gleason 7 prostate adenocarcinoma is not yet standardized, as indicated by the variability of LND dissection rates. Receipt of LND did not improve CSM, and in G43 patients, it predicted higher CSM. As the effect of LND on CSM is uncertain, further evaluation of oncologic benefit in this patient population is warranted. 相似文献35.
36.
Álvaro Jesús Bernal Martínez Nieves Fernández Letamendi Julio Delgado Martínez Lucía Gómez-Escolar Larrañaga Enara Reola Ramírez Javier Puertas Peña 《Cirugía espa?ola》2018,96(9):577-582
Introduction
It is unknown whether cervical lymphadenectomy as a treatment for cutaneous squamous cell carcinoma of the head and neck (cSCCh&n) increases survival in elderly patients. The aim of this study is to determine whether this procedure has an influence on the survival of these patients, and whether the Short-Form Charlson Comorbidity Index (CCI-SF) can be used as an alternative to age in the surgeon's estimation of elderly patient mortality.Methods
The study population included all patients diagnosed with cSCCh&n consecutively treated between 2006 and 2011. Non-invasive, non-cutaneous carcinomas were excluded. Patients were grouped according to their age (< 70, 70-79, 80-89, > 90), CCI-SF (< 3, ≥ 3) and presence (N1) or absence (N0) of cervical metastases. The dependent variable was the performance or not of cervical lymphadenectomy. A univariate survival analysis was performed according to the presence of metastases, a bivariate analysis for each of the independent variables according to the received treatment and a multivariate analysis.Results
416 cases were included. The mean survival time was greater in the N0 group. For each of the groups based on the presence of metastasis, the differences in the mean survival time according to age and CCI-SF were not significant, regardless of the treatment received. The multivariate analysis showed the influence of age (p = 0.0001, OR = 1.488, 95%CI = [1.318; 1.679]) and CCI-SF (p = 0.001, OR = 1.817, 95%CI = [1.257; 2.627]) in the N0 group. In the N1 group only regional treatment has a positive influence on survival (p = 0.048, OR = 0.15, 95%CI = [0.023; 0.981]).Conclusions
CCI-SF and age are good mortality indicators in cSCCh&n N0 patients, but not so in cSCCh&n N1 patients. In cSCCh&n N1 patients, regional treatment has a positive influence on survival. Differences cannot be affirmed in the mean survival time of patients with cSCCh&n, based on the development of metastases and the treatment given. New studies will be necessary. 相似文献37.
Thomas C. Tsai Jordan Miller Ciro Andolfi Brian Whang P. Marco Fisichella 《European journal of surgical oncology》2018,44(8):1177-1180
The extent of lymphadenectomy for esophageal adenocarcinoma remains controversial. Outstanding issues include the appropriate technical approach such as transthoracic versus transhiatal, or open versus minimally invasive, both of which have implications on overall lymph node harvest numbers and morbidity. Recent data on the relationship of total number of lymph nodes harvested and oncologic survival have been conflicting, due in part to a likely differential impact of lymphadenectomy on survival based on tumor stage and response to neoadjuvant therapy. While standardizing the extent of lymphadenectomy may be desirable, a more useful approach might be to tailor lymphadenectomy considering the multidimensional impact of surgical technique and multimodal treatment strategy. 相似文献
38.
39.
Pelvic lymph node metastases from bladder cancer occur in about 25% of patients undergoing radical cystectomy. While the majority
of patients with lymph node metastases will develop progressive disease, some patients do exhibit long-term survival with
and without adjuvant chemotherapy. The concept of lymph node density has been proposed as a means to stratify patient prognosis
since it takes into account two important factors—the number of positive nodes (tumor burden) and the total number of nodes
removed/examined (extent of dissection). Due to the lack of agreement on the extent of lymphadenectomy, lymph node density
facilitates standardization of lymph node staging, thus allowing for adjuvant therapies and clinical trials to be more uniformly
applied. Whether lymph node density provides improved prognostication over the standard nodal staging or absolute number of
positive lymph nodes remains controversial. We review the literature regarding the role of lymph node density in the prognostic
stratification of node-positive bladder cancer. 相似文献
40.
Liu T Zhang C Yu P Chen J Zeng D Gan L Lv W Liu L Yan X 《Clinical colorectal cancer》2011,10(3):183-187