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Japanese Journal of Clinical Oncology May 2020Sentinel node navigation surgery (SNNS) has been frequently used in early cervical cancer. However, the incidence and potential reduction of lymphatic complications... (Comparative Study)
Comparative Study
BACKGROUND
Sentinel node navigation surgery (SNNS) has been frequently used in early cervical cancer. However, the incidence and potential reduction of lymphatic complications following the removal of the sentinel lymph node remain unknown. Thus, this study aimed to evaluate the occurrence of lymphatic complications post sentinel node navigation surgery in patients with early cervical cancer.
METHODS
A total of 167 patients, including 70 and 97 patients who had undergone SNNS and pelvic lymphadenectomy (PLA), respectively, were enrolled in this study. We compared the lymphatic complications (lower extremity lymphedema and pelvic lymphocele) between the SNNS and PLA groups.
RESULTS
The median number of sentinel lymph nodes removed was 2 (range: 1-14). Among the 70 patients in the SNNS group, there were 0 (0%) and 3 (4.3%) occurrences of lower extremity lymphedema and pelvic lymphocele, respectively. The occurrences of lower extremity lymphedema and pelvic lymphocele were significantly lower in the SNNS group than in the PLA group, despite circumflex iliac node removal.
CONCLUSIONS
The occurrence of lymphatic complications (lower extremity lymphedema and pelvic lymphocele) was significantly lower in the SNNS group than in the PLA group. We found that SNNS, and not PLA, was the best treatment option for preventing the development of lower extremity lymphedema and pelvic lymphocele, despite circumflex iliac node preservation.
Topics: Adult; Aged; Female; Humans; Lymph Node Excision; Lymphedema; Lymphocele; Middle Aged; Pelvis; Postoperative Complications; Risk Factors; Sentinel Lymph Node; Uterine Cervical Neoplasms; Young Adult
PubMed: 32104889
DOI: 10.1093/jjco/hyaa001 -
The Urologic Clinics of North America Aug 2024Penile cancer with bulky inguinal metastasis has a high probability of harboring pathologically involved lymph nodes best managed in a multidisciplinary care setting.... (Review)
Review
Penile cancer with bulky inguinal metastasis has a high probability of harboring pathologically involved lymph nodes best managed in a multidisciplinary care setting. Appropriate staging with cross-sectional imaging and fine-needle aspirate cytology of suspicious nodes guide decision-making for the use of platinum-based neoadjuvant chemotherapy followed by inguinal lymph node dissection. Surgical resection plays an important diagnostic, therapeutic, and guiding role in disease management. Patients with adverse pathologic features, especially those with extranodal disease extension, may derive additional benefit from adjuvant radiotherapy.
Topics: Humans; Lymphatic Metastasis; Inguinal Canal; Male; Penile Neoplasms; Lymph Node Excision; Lymph Nodes; Pelvis; Neoplasm Staging
PubMed: 38925736
DOI: 10.1016/j.ucl.2024.03.012 -
Minimally Invasive Therapy & Allied... Feb 2020A three-dimensional (3D) model of the pelvic vessels was reconstructed before surgery to aid in the understanding of the individual anatomy and help guide...
A three-dimensional (3D) model of the pelvic vessels was reconstructed before surgery to aid in the understanding of the individual anatomy and help guide lymphadenectomy performance. Thirty patients with early-stage cervical cancer who were scheduled for lymphadenectomy at Nanfang Hospital, Southern Medical University from January 2017 to June 2017 were included. Three-dimensional models of the pelvic vessels were obtained. All 3D models of the 30 patients were reconstructed successfully and were consistent with the operative findings.The most common structural types posterior to the common iliac artery (CIA) and CIA bifurcation (CIAB) were non-vessel structures (23/30 patients) and the common iliac vein (CIV) (27/30); these were observed separately on the left pelvic vein. The confluence of common iliac vein (CCIV) (29/30) and CIV (20/30) were most commonly observed posterior to the CIA and CIAB; these were observed separately on the right pelvic vein. Venous abnormalities were identified in 15 patients. There were variants in venous confluence shown to be homolateral to the CIV (2/15) and contralateral to the CIV (2/15) and CCIV (4/15). Three-dimensional models of the pelvic vessels can provide information on individual anatomy features that can help guide lymphadenectomy performance.
Topics: Adult; Aorta, Abdominal; Female; Humans; Iliac Artery; Iliac Vein; Lymph Node Excision; Middle Aged; Models, Anatomic; Pelvis; Uterine Cervical Neoplasms; Vena Cava, Inferior
PubMed: 30794060
DOI: 10.1080/13645706.2019.1569533 -
Journal of Plastic, Reconstructive &... Mar 2022Pelvic lymphoceles are the most common complications after pelvic lymphadenectomy. Microsurgical procedures have attracted attention as an alternative treatment for...
BACKGROUND
Pelvic lymphoceles are the most common complications after pelvic lymphadenectomy. Microsurgical procedures have attracted attention as an alternative treatment for lymphoceles. Here, we report six cases of refractory lymphoceles that were successfully treated using lymphovenous anastomosis (LVA).
METHODS
Six patients underwent surgery for gynecological cancers and developed pelvic lymphoceles, which did not respond to conventional treatment. We mainly performed LVA on the ipsilateral lower limbs, although some procedures were also performed on the contralateral limbs. The change in the lymphocele volume after LVA was examined using computed tomography and compared using the Wilcoxon test.
RESULTS
Five of the six refractory lymphocele cases were successfully treated using LVA, and the remaining case exhibited an 87% reduction in lymphocele volume. The average numbers of anastomoses were 6.7 on the ipsilateral side and 2.8 on the contralateral side (the median numbers: 6 [range: 5-9] vs. 3 [range: 1-4], P = 0.034). The average lymphocele volume decreased significantly from 414.0 mL preoperatively to 8.0 mL postoperatively (the median lymphocele volume: 255.8 [range: 61.5-1,329.2] vs. 0 [range: 0-47.7], P = 0.0313).
CONCLUSION
We found that microsurgical treatment was potentially effective for lymphoceles that did not respond to conventional treatment.
Topics: Anastomosis, Surgical; Female; Gynecologic Surgical Procedures; Humans; Lymph Node Excision; Lymphocele; Neoplasms; Pelvis
PubMed: 34840117
DOI: 10.1016/j.bjps.2021.09.056 -
Anticancer Research Aug 2021To compare the surgical outcomes of robotic and laparoscopic hysterectomy with or without pelvic lymphadenectomy among obese patients [body mass index (BMI) >30 kg/m]... (Comparative Study)
Comparative Study
BACKGROUND/AIM
To compare the surgical outcomes of robotic and laparoscopic hysterectomy with or without pelvic lymphadenectomy among obese patients [body mass index (BMI) >30 kg/m] with early-stage endometrial cancer.
PATIENTS AND METHODS
We examined 42 obese patients with early-stage endometrial cancer who underwent laparoscopic (LH) or robotic hysterectomy (RH) between April 2014 and April 2020 in our institution. We analysed intraoperative and postoperative data for both procedures.
RESULTS
Of the 42 women, 22 and 20 patients underwent RH and LH, respectively, with or without pelvic lymphadenectomy. The operation times, harvested lymph nodes, and BMI did not differ between the groups. In the subset of patients who underwent pelvic lymphadenectomy, those in the RH group had shorter hospital stays (p=0.001) and less intraoperative bleeding (p=0.006).
CONCLUSION
Obese patients with endometrial cancer who underwent robotic surgery had less blood loss and shorter hospital stays than those who underwent laparoscopic surgery.
Topics: Adult; Aged; Endometrial Neoplasms; Female; Humans; Hysterectomy; Laparoscopy; Length of Stay; Lymph Node Excision; Middle Aged; Obesity; Pelvis; Retrospective Studies; Robotic Surgical Procedures
PubMed: 34281888
DOI: 10.21873/anticanres.15220 -
Journal of Endourology Sep 2023This systematic review and meta-analysis investigated whether peritoneal interposition flap (PIF) prevent lymphocele formation after robot-assisted radical... (Meta-Analysis)
Meta-Analysis
Effect of Peritoneal Interposition Flap to Prevent Symptomatic Lymphoceles in Robot-Assisted Radical Prostatectomy with Pelvic Lymphadenectomy: A Meta-Analysis and Systematic Review.
This systematic review and meta-analysis investigated whether peritoneal interposition flap (PIF) prevent lymphocele formation after robot-assisted radical prostatectomy with extended pelvic lymph node dissection. We performed a systematic review and cumulative meta-analysis of the primary outcomes according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Assessing the Methodological Quality of Systematic Reviews guidelines and risk-of-bias tool. Five databases, including Medline, PubMed, Cochrane Library, Scopus, and Web of Science, were systematically searched. The time frame of the search was set from the creation of the database to February 2023. Meta-analysis of symptomatic lymphoceles (sLCs) rates revealed significant difference between PIF and no PIF group (eight studies pooled; = 0.005), The sLCs rates account for 2.6% (28/1074) and 7.1% (85/1186) in the PIF and no PIF group, respectively. The resulting odds ratio was 0.34 (95% confidence interval: 0.16-0.73), taking into account the heterogeneity of these studies ( = 14.32, = 0.05; = 51%). PIF is an effective intraoperative modification on the prevention or reduction of sLC, which is worthy of further clinical promotion. National Institute for Health and Care Research, identifier CRD42022364461.
Topics: Male; Humans; Lymphocele; Robotics; Lymph Node Excision; Robotic Surgical Procedures; Prostatectomy
PubMed: 37493580
DOI: 10.1089/end.2023.0127 -
Gynecologic Oncology Aug 2020
Topics: Conization; Female; Fertility Preservation; Humans; Lymph Node Excision; Uterine Cervical Neoplasms
PubMed: 32778250
DOI: 10.1016/j.ygyno.2020.07.003 -
International Journal of Colorectal... Aug 2020Lateral pelvic lymph node metastasis occurs in 15 to 20% of patients with locally advanced low rectal cancer which increases risk of local recurrence and reduced... (Review)
Review
PURPOSE
Lateral pelvic lymph node metastasis occurs in 15 to 20% of patients with locally advanced low rectal cancer which increases risk of local recurrence and reduced survival following neoadjuvant chemoradiotherapy (nCRT) and total mesorectal excision (TME). Adding lateral pelvic lymph node dissection (LPLND) could improve outcomes in those patients. This review aims to determine if the addition of LPLND to the conventional management of advanced rectal cancer would yield improved outcomes.
METHODS
OVID Medline, Cochrane, Clinicaltrials.gov , EMBASE, Clinicaltrialsregister.eu, Web of Knowledge and CABAbstracts were searched using the following keywords: 'lateral pelvic lymph node dissection', 'pelvis lymphadenectomy', 'chemoradi*', 'rectal cancer', 'rectal neoplasm', 'rectal carcinoma' and 'rectal tumour'. Studies were included if they were in English and included rectal cancer patients that had nCRT, rectal resection ± LPLND. Primary outcome was 3-year and 5-year local recurrence. Secondary outcome was 3-year and 5-year overall survival.
RESULTS
Six studies were identified with 1210 patients who had nCRT and TME, and 268 patients who had nCRT and rectal resection plus LPLND. Patients who had LPLND had non-significant lower 3-year and 5-year local recurrence rate compared with those who did not (p = 0.10 and p = 0.12, respectively). They demonstrated a lower 3-year overall survival but higher 5-year overall survival and both were not significant (p = 0.81 and p = 0.57, respectively).
CONCLUSION
Available evidence suggests that there is no significant reduction in local recurrence rates or improved survival from LPLND to the current treatment modalities. Further studies are required to define the role of lateral pelvic lymph node dissection in low rectal cancer.
Topics: Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Pelvis; Rectal Neoplasms; Retrospective Studies
PubMed: 32504333
DOI: 10.1007/s00384-020-03656-1 -
International Journal of Gynaecology... Aug 2020To compare outcomes and prognosis among women with type I endometrial cancer undergoing hysterectomy and bilateral salpingo-oophorectomy (H-BSO) with or without...
OBJECTIVE
To compare outcomes and prognosis among women with type I endometrial cancer undergoing hysterectomy and bilateral salpingo-oophorectomy (H-BSO) with or without systematic pelvic lymphadenectomy (PLD) or para-aortic lymphadenectomy (PALD).
METHODS
Retrospective review of women postoperatively diagnosed with type I endometrial cancer who underwent H-BSO at a university hospital in Chengdu, China (January 2010 to June 2012). Women were divided into no lymphadenectomy (PLD-/PALD-), systematic pelvic lymphadenectomy (PLD+/PALD-), or combined pelvic and para-aortic lymphadenectomy (PLD+/PALD+) groups. Follow-up was by telephone. Postoperative outcomes and prognosis were compared and risk factors were analyzed.
RESULTS
In total, 333 women met the inclusion criteria: 121 underwent PLD+/PALD-, 166 underwent PLD+/PALD+, and 46 underwent PLD-/PALD-. There were no differences in pre-operative characteristics among the groups (all P>0.05). The PLD+/PALD+ group had a higher laparotomy rate (P=0.001), the PLD-/PALD- group had shorter operation time (P=0.001) and lower blood loss (P<0.001). There were no differences between the PLD+/PALD- and PLD+/PALD+ groups. Overall, 291 women had sufficient follow-up data; there was no difference in overall survival, and PALD was not a predictor of survival.
CONCLUSION
Postoperative outcomes were similar among all surgical groups; a survival benefit of PALD was not demonstrated.
Topics: Adult; Aged; Case-Control Studies; China; Endometrial Neoplasms; Female; Humans; Lymph Node Excision; Lymphatic Metastasis; Middle Aged; Pelvis; Retrospective Studies
PubMed: 32433783
DOI: 10.1002/ijgo.13228 -
European Journal of Surgical Oncology :... Jul 2020Evidence on uterine serous cancer (USC) prognosis has been limited and inconclusive. We aim to explore the survival benefits of comprehensive lymphadenectomy in USC...
OBJECTIVE
Evidence on uterine serous cancer (USC) prognosis has been limited and inconclusive. We aim to explore the survival benefits of comprehensive lymphadenectomy in USC patients after surgery and develop a prognostic nomogram to predict survival.
METHODS
USC patients who had undergone hysterectomy between 2010 and 2015 were identified from Surveillance, Epidemiology and End Results (SEER) database. The relationship between the extent of lymphadenectomy and survival, including overall survival (OS) and cancer-specific survival (CSS), was estimated with Kaplan-Meier (K-M) analysis. Univariate and multivariate Cox regression analyses were utilized to determine the independent prognostic factors. A nomogram was then developed, calibrated and internally validated.
RESULTS
A total of 2853 patients were identified. K-M survival analysis revealed that patients with ≥12 pelvic lymph nodes (PLNs) removed had significantly better OS and CSS than those without (both P < 0.001). However, patients with ≥6 para-aortic lymph nodes removed was not associated with similar survival benefits than patients without (P > 0.1). Multivariate analyses for OS and CSS revealed that age, T-stage, N-stage, tumor size, adjuvant therapy and ≥12 PLNs removed were independent prognostic factors (all P < 0.05) and were subsequently incorporated into the nomogram. The Harrell's C-index of the nomogram was significantly higher than that of the FIGO staging system (OS: 0.739 vs 0.671, P < 0.001; CSS: 0.752 vs 0.695, P < 0.001). Furthermore, the nomogram was well calibrated with satisfactory consistency.
CONCLUSIONS
Comprehensive pelvic lymphadenectomy should be recommended to USC patients for its survival benefits. And a nomogram has been developed to predict the survivals of USC patients after surgery.
Topics: Age Factors; Aorta; Carcinoma; Combined Modality Therapy; Female; Humans; Hysterectomy; Kaplan-Meier Estimate; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Middle Aged; Neoplasm Staging; Nomograms; Pelvis; Proportional Hazards Models; SEER Program; Survival Rate; Tumor Burden; United States; Uterine Neoplasms
PubMed: 32402510
DOI: 10.1016/j.ejso.2020.04.055