Lymphadenectomy in Gleason 7 prostate cancer: Adherence to guidelines and effect on clinical outcomes

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).

Evaluación del tratamiento del carcinoma epidermoide cutáneo de cabeza y cuello en la edad avanzada. Análisis de la supervivencia

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.

Surgical evaluation of lymph nodes in esophageal adenocarcinoma: Standardized approach or personalized medicine?

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.     

腹腔镜与开腹宫颈癌根治术的临床对比分析

目的探讨腹腔镜与传统开腹宫颈癌根治术的治疗效果。方法回顾分析30例Ⅰa～Ⅱb期行腹腔镜下宫颈癌根治术患者与同期33例开腹手术患者的临床资料。结果腹腔镜组与开腹组手术时间、术中出血量、术后肛门排气时间、下床活动时间、住院天数、术后伤口感染发生率等差异均有统计学意义（P〈0．01或P〈0．05）,而清扫淋巴结数目差异无统计学意义（P〉0．05）。结论腹腔镜下宫颈癌根治术是安全可行的,且具有手术切口小、创伤小、术后恢复快等优点。     

The role of lymph node density in bladder cancer prognostication

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.     

肺癌手术中淋巴结清扫的现状与进展

淋巴结转移是肺癌主要而常见的转移途径,也是术后癌残留而导致复发和转移的主要因素,肺癌手术中纵隔、肺门淋巴结清扫至关重要。但目前淋巴结的清扫方式尚不统一,有系统淋巴结清扫术（CMLND）、根治性淋巴结清扫术、淋巴结采样、系统淋巴结采样以及前哨淋巴结技术导航切除,并且随着微创外科的发展,胸腔镜下淋巴结清扫也日趋成熟。而寻求一个更规范、更完善的淋巴结清扫方式甚有必要。现就目前肺癌手术中纵隔、肺门淋巴结清扫的临床意义、清扫方式、清扫范围以及胸腔镜下淋巴结清扫的现状以及展望进行综述。     

Laparoscopic radical correction combined with extensive lymphadenectomy and pelvic autonomic nerve preservation for mid-to-low rectal cancer

Objective

The purposes of this study were to confirm the definite metastasis and micrometastasis rate of upward and lateral lymph nodes of mid-to-low rectal cancer at stage II and stage III, and to evaluate the feasibility and safety of laparoscopic radical correction combined with extensive lymphadenectomy and pelvic autonomic nerve preservation (PANP).

Methods

The study was performed in 68 patients who were diagnosed with mid-to-low rectal cancer at stage II or stage III and received laparoscopic radical correction combined with extensive lymphadenectomy and PANP from June 2006 to June 2008 in the General Surgery Department of Southwest Hospital. All lymph nodes resected in the surgeries were examined by hematoxylin and eosin (H & E) stain and immunohistochemistry with an antibody against cytokeratin 20 (CK20) to confirm the conditions of metastasis and micrometastasis. We compared the postoperative complications with those of traditional surgeries.

Results

In 1571 lymph nodes, 16 lymph nodes were found to have definite metastasis in 6 patients (8.8%) and in 41 lymph nodes we found micrometastasis in 12 patients (17.6%). The total metastasis rate of upward and lateral lymph nodes was 19.1%. Compared with traditional surgeries, the new surgery had less blood loss and short convalescence and postoperative complications were not increased.

Conclusion

The total metastasis rate of upward and lateral lymph nodes is 19.1%. The laparoscopic radical correction combined with extensive lymphadenectomy and PANP is feasible and safe.     

系统性盆腔及腹主动脉旁淋巴结清扫术在晚期卵巢上皮性恶性肿瘤预后的价值：一项Meta资料分析与研究

目的评价系统性盆腔及腹主动脉旁淋巴结清扫术对晚期卵巢上皮性恶性肿瘤预后的影响。方法计算机检索PUBMED数据库,试验组为晚期卵巢上皮性恶性肿瘤行满意肿瘤细胞减灭术＋系统性盆腔及腹主动脉旁淋巴结清扫术,对照组仅行满意肿瘤细胞减灭术,术后均行规范化疗。采用RevMan4.2软件进行meta分析。以患者的生存率、围手术期并发症发生率为疗效观察指标,合并RR值比较清扫组与未清扫组的三年总生存率（OS）、5年总生存率、围手术期并发症发生率。结果共有5个临床试验包括899例病人符合纳入标准。结果显示,在满意的肿瘤细胞减灭术下淋巴结清扫组较未清扫组：（1）3年OS无显著性差异（RR=1.06,95%CI：0.94～1.20,p=0.35）;（2）5年OS无显著性差异（RR=1.17,95%CI：0.98～1.39,p=0.08）;（3）清扫组围手术期并发症发生率远较对照组高（RR=1.58,95%CI：1.15～2.18,p=0.005）,差异有统计学意义。结论在理想肿瘤细胞减灭术下,系统性盆腔及腹主动脉旁淋巴结清扫术不能改善患者的3年OS,亦不能提高其5年OS。而围手术期并发症发生率显著提高,尽管主要归因于淋巴囊肿的形成.     

Prognostic Value of Lymph Node Yield and Metastatic Lymph Node Ratio in Medullary Thyroid Carcinoma

Introduction  Lymphadenectomy and thyroidectomy is standard treatment for medullary thyroid carcinoma (MTC), but the prognostic importance of the number of lymph nodes removed (lymph node yield, LNY) and the proportion of metastatic lymph nodes resected (metastatic lymph node ratio, MLNR) is unknown. We hypothesized that MTC survival is influenced by LNY and MLNR. Methods  Patients (N = 534) who underwent thyroidectomy with lymphadenectomy for MTC between 1988 and 2004 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. The Kaplan–Meier method was used for univariate comparisons of survival for LNY and MLNR with a maximum follow-up of 12 years. Cox regression models adjusted for age, sex, extent of disease, tumor size, nodal status, LNY, and MLNR. Results  By univariate analysis, increasing LNY was associated with improved survival in all patients (P < 0.002) and node-positive patients (P < 0.001). In a multivariate analysis using LNY and MLNR as categorical variables, significant factors influencing survival included: age (P < 0.001), tumor size (P < 0.001), LNY (P = 0.007), and MLNR (P < 0.02); in node-negative patients: age (P = 0.002); in node-positive patients: age (P < 0.001), tumor size (P < 0.001), and LNY (P = 0.001). Using LNY and MLNR as continuous variables, significant factors influencing survival included: age (P < 0.001), tumor size (P < 0.001), and MLNR (P = 0.01); in node-negative patients: age (P < 0.001); in node-positive patients: age (P < 0.001) and tumor size (P < 0.001). Conclusion  In patients undergoing thyroidectomy and lymphadenectomy for MTC, LNY and MLNR predict poorer survival, but their impact on survival was limited to node-positive patients and was otherwise dominated by the effects of age and extent of disease. Supported by Grant Number KL2RR024144 from the National Center for Research Resources. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health. Presented in part at the 3rd Annual Academic Surgical Congress, February 12–15, 2008, Huntington Beach, California.