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Zaveri S, Lillemoe HA, Teshome M, Reyna CR, Vreeland TJ, Francescatti AB, Zheng L, Hunt KK, Katz MHG, Kilgore LJ. Operative standards for sentinel lymph node biopsy and axillary lymphadenectomy for breast cancer: review of the American College of Surgeons commission on cancer standards 5.3 and 5.4. Surgery 2023; 174:717-721. [PMID: 37202308 DOI: 10.1016/j.surg.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/06/2023] [Accepted: 04/09/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Shruti Zaveri
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX. https://twitter.com/shrutizaveriMD
| | - Heather A Lillemoe
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX. https://twitter.com/hillemoe
| | - Mediget Teshome
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX; Cancer Surgery Standards Program, American College of Surgeons, Chicago, IL. https://twitter.com/drmediget
| | - Chantal R Reyna
- Department of Surgery, Crozer Health, Upland, PA. https://twitter.com/kprgrl3
| | - Timothy J Vreeland
- Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX; Cancer Surgery Standards Program, American College of Surgeons, Chicago, IL. https://twitter.com/vreelant
| | | | - Linda Zheng
- Cancer Surgery Standards Program, American College of Surgeons, Chicago, IL. https://twitter.com/lindazheng_ACS
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX; Cancer Surgery Standards Program, American College of Surgeons, Chicago, IL. https://twitter.com/kellykhunt
| | - Matthew H G Katz
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX; Cancer Surgery Standards Program, American College of Surgeons, Chicago, IL. https://twitter.com/mkatzmd
| | - Lyndsey J Kilgore
- Department of Surgery, Division of Breast Surgical Oncology, University of Kansas Cancer Center, Kansas City, KS.
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Wang Z, Ke N, Wang X, Wang X, Chen Y, Chen H, Liu J, He D, Tian B, Li A, Hu W, Li K, Liu X. Optimal extent of lymphadenectomy for radical surgery of pancreatic head adenocarcinoma: 2-year survival rate results of single-center, prospective, randomized controlled study. Medicine (Baltimore) 2021; 100:e26918. [PMID: 34477122 PMCID: PMC8415937 DOI: 10.1097/md.0000000000026918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/23/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Radical pancreaticoduodenectomy is the only possible cure for pancreatic head adenocarcinoma, and although several RCT studies have suggested the extent of lymph node dissection, this issue remains controversial. This article wanted to evaluate the survival benefit of different lymph node dissection extent for radical surgical treatment of pancreatic head adenocarcinoma. METHODS A total of 240 patients were assessed for eligibility in the study, 212 of whom were randomly divided into standard lymphadenectomy group (SG) or extended lymphadenectomy group (EG), there were 97 patients in SG and 95 patients in EG receiving the radical pancreaticoduodenectomy. RESULT The demography, histopathology and clinical characteristics were similar between the 2 groups. The 2-year overall survival rate in the SG was higher than the EG (39.5% vs 25.3%; P = .034). The 2-year overall survival rate in the SG who received postoperative adjuvant chemotherapy was higher than the EG (60.7% vs 37.1%; P = .021). There was no significant difference in the overall incidence of complications between the 2 groups (P = .502). The overall recurrence rate in the SG and EG (70.7% vs 77.5%; P = .349), and the patterns of recurrence between 2 groups were no significant differences. CONCLUSION In multimodality therapy system, the efficacy of chemotherapy should be based on the appropriate lymphadenectomy extent, and the standard extent of lymphadenectomy is optimal for resectable pancreatic head adenocarcinoma. The postoperative slowing of peripheral blood lymphocyte recovery might be 1 of the reasons why extended lymphadenectomy did not result in survival benefits. CLINICAL TRIAL REGISTRATION This trial was registered at ClinicalTrials.gov (NCT02928081) in October 7, 2016. https://clinicaltrials.gov/.
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Affiliation(s)
- Ziyao Wang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Nengwen Ke
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Wang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xing Wang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yonghua Chen
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hongyu Chen
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jinheng Liu
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Du He
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Bole Tian
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ang Li
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Weiming Hu
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Kezhou Li
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xubao Liu
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
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Broman KK, Hughes TM, Dossett LA, Sun J, Carr MJ, Kirichenko DA, Sharma A, Bartlett EK, Nijhuis AA, Thompson JF, Hieken TJ, Kottschade L, Downs J, Gyorki DE, Stahlie E, van Akkooi A, Ollila DW, Frank J, Song Y, Karakousis G, Moncrieff M, Nobes J, Vetto J, Han D, Farma J, Deneve JL, Fleming MD, Perez M, Baecher K, Lowe M, Bagge RO, Mattsson J, Lee AY, Berman RS, Chai H, Kroon HM, Teras RM, Teras J, Farrow NE, Beasley GM, Hui JY, Been L, Kruijff S, Boulware D, Sarnaik AA, Sondak VK, Zager JS. Surveillance of Sentinel Node-Positive Melanoma Patients with Reasons for Exclusion from MSLT-II: Multi-Institutional Propensity Score Matched Analysis. J Am Coll Surg 2021; 232:424-431. [PMID: 33316427 PMCID: PMC8764869 DOI: 10.1016/j.jamcollsurg.2020.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND In sentinel lymph node (SLN)-positive melanoma, two randomized trials demonstrated equivalent melanoma-specific survival with nodal surveillance vs completion lymph node dissection (CLND). Patients with microsatellites, extranodal extension (ENE) in the SLN, or >3 positive SLNs constitute a high-risk group largely excluded from the randomized trials, for whom appropriate management remains unknown. STUDY DESIGN SLN-positive patients with any of the three high-risk features were identified from an international cohort. CLND patients were matched 1:1 with surveillance patients using propensity scores. Risk of any-site recurrence, SLN-basin-only recurrence, and melanoma-specific mortality were compared. RESULTS Among 1,154 SLN-positive patients, 166 had ENE, microsatellites, and/or >3 positive SLN. At 18.5 months median follow-up, 49% had recurrence (vs 26% in patients without high-risk features, p < 0.01). Among high-risk patients, 52 (31%) underwent CLND and 114 (69%) received surveillance. Fifty-one CLND patients were matched to 51 surveillance patients. The matched cohort was balanced on tumor, nodal, and adjuvant treatment factors. There were no significant differences in any-site recurrence (CLND 49%, surveillance 45%, p = 0.99), SLN-basin-only recurrence (CLND 6%, surveillance 14%, p = 0.20), or melanoma-specific mortality (CLND 14%, surveillance 12%, p = 0.86). CONCLUSIONS SLN-positive patients with microsatellites, ENE, or >3 positive SLN constitute a high-risk group with a 2-fold greater recurrence risk. For those managed with nodal surveillance, SLN-basin recurrences were more frequent, but all-site recurrence and melanoma-specific mortality were comparable to patients treated with CLND. Most recurrences were outside the SLN-basin, supporting use of nodal surveillance for SLN-positive patients with microsatellites, ENE, and/or >3 positive SLN.
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Affiliation(s)
- Kristy K Broman
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL; Department of Oncologic Sciences, University of South Florida, Tampa, FL; Department of Surgery, University of Alabama at Birmingham.
| | - Tasha M Hughes
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Lesly A Dossett
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - James Sun
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL; Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Michael J Carr
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL
| | | | - Avinash Sharma
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Edmund K Bartlett
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Amanda Ag Nijhuis
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | | | - Lisa Kottschade
- Department of Oncology, Division of Medical Oncology, Mayo Clinic, Rochester, MN
| | - Jennifer Downs
- Division of Cancer Surgery, Peter MacCallum Cancer Center, Melbourne, Australia
| | - David E Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Center, Melbourne, Australia
| | - Emma Stahlie
- Division of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Alexander van Akkooi
- Division of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - David W Ollila
- Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Jill Frank
- Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Yun Song
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | | | - Marc Moncrieff
- Department of Plastic Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Jenny Nobes
- Department of Plastic Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - John Vetto
- Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Dale Han
- Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Jeffrey Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Jeremiah L Deneve
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Martin D Fleming
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Matthew Perez
- Department of Surgery, Emory University, Atlanta, GA
| | | | - Michael Lowe
- Department of Surgery, Emory University, Atlanta, GA
| | - Roger Olofsson Bagge
- Sahlgrenska Center for Cancer Research, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Mattsson
- Sahlgrenska Center for Cancer Research, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ann Y Lee
- Department of Surgery, NYU Langone Health, New York, NY
| | | | - Harvey Chai
- Department of Surgery, Royal Adelaide Hospital, Adelaide, Australia; Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Hidde M Kroon
- Department of Surgery, Royal Adelaide Hospital, Adelaide, Australia; Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Roland M Teras
- Surgery Clinic, North Estonia Medical Centre Foundation, Tallinn, Estonia
| | - Juri Teras
- Surgery Clinic, North Estonia Medical Centre Foundation, Tallinn, Estonia
| | | | | | - Jane Yc Hui
- Department of Surgery, University of Minnesota, Minneapolis, MN
| | - Lukas Been
- Department of Surgical Oncology, University of Groningen, University Medical Center, Groningen, Netherlands
| | - Schelto Kruijff
- Department of Surgical Oncology, University of Groningen, University Medical Center, Groningen, Netherlands
| | - David Boulware
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL
| | - Amod A Sarnaik
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL; Department of Oncologic Sciences, University of South Florida, Tampa, FL
| | - Vernon K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL; Department of Oncologic Sciences, University of South Florida, Tampa, FL
| | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL; Department of Oncologic Sciences, University of South Florida, Tampa, FL
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Voron T, Romain B, Bergeat D, Véziant J, Gagnière J, Le Roy B, Pasquer A, Eveno C, Gaujoux S, Pezet D, Gronnier C. Surgical management of gastric adenocarcinoma. Official expert recommendations delivered under the aegis of the French Association of Surgery (AFC). J Visc Surg 2020; 157:117-126. [PMID: 32151595 DOI: 10.1016/j.jviscsurg.2020.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Gastric adenocarcinoma (GA) is the 5th most common cancer in the world; in France, however, its incidence has been steadily decreasing. Twenty-five experts brought together under the aegis of the French Association of Surgery collaborated in the drafting of a series of recommendations for surgical management of GA. As concerns preoperative evaluation and work-up, echo-endoscopy aimed at clarifying lymph node status should be performed in all candidates for surgical resection and exploratory laparoscopy in cases of GA cT3/T4 and/or N+ for peritoneal carcinomatosis. On the other hand, PET-scan should not be performed systematically, but only when the other modalities for diagnosis prove insufficient. Laparotomy remains the route of choice to achieve total or partial gastrectomy with D2 lymph node lymphadenectomy for advanced lesions (>T2N0). To limit the risk of dumping syndrome and esophageal reflux and as a way of reestablishing continuity, construction of a jejunal pouch on Roux-en-Y following total gastrectomy is recommended. In cases of peritoneal carcinosis in GA with a low peritoneal cancer index (PCI) (<7) in a patient in good general condition whose disease is controlled by chemotherapy, macroscopically complete cytoreduction with intraperitoneal hyperthermal chemotherapy will probably be required, and it will have to take place in an expert center. Only in the event of Child A cirrhosis may gastrectomy with D2 lymphadenectomy be considered. Palliative gastrectomy or surgical bypass for distal stomach obstruction in a patient in good general condition may also be envisioned.
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Affiliation(s)
- T Voron
- General and Digestive Surgery Department, Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France.
| | - B Romain
- General and Digestive Surgery Department, Hautepierre Hospital, Strasbourg, France.
| | - D Bergeat
- Hepato-biliary and digestive surgery Department, Pontchaillou Hospital, 2 rue Henri Le Guilloux, 35033 Rennes, France.
| | - J Véziant
- Hepato-biliary and digestive surgery Department-Hepatic Transplantation U1071 Inserm/University Clermont-Auvergne CHU Estaing, 1, place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand cedex 1, France.
| | - J Gagnière
- Hepato-biliary and digestive surgery Department-Hepatic Transplantation U1071 Inserm/University Clermont-Auvergne CHU Estaing, 1, place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand cedex 1, France.
| | - B Le Roy
- Digestive surgery and oncology Department, CHU Nord Saint-Etienne, Avenue Albert Raymond, 42270 Saint-Priest-en-Jarez, France.
| | - A Pasquer
- Digestive surgery Department, Édouard Herriot Hospital, Hospices Civils de Lyon, Place d'Arsonval, 69437 Lyon cedex, France.
| | - C Eveno
- Digestive surgery and oncology Department, Claude Huriez Hospital, 59000 Lille, France.
| | - S Gaujoux
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Paris-Descartes University Hôpital Cochin-Pavillon Pasteur, 27 rue du Faubourg Saint Jacques, 75014 Paris, France.
| | - D Pezet
- Hepato-biliary and digestive surgery Department-Hepatic Transplantation U1071 Inserm/University Clermont-Auvergne CHU Estaing, 1, place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand cedex 1, France.
| | - C Gronnier
- Digestive surgery Department, Medico-chirurgical Center Magellan, avenue de Magellan, 33604 Pessac, France.
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Abstract
PURPOSE OF REVIEW This review describes the long scientific background followed to design guidelines and everyday clinical practice applied to melanoma patients. Surgery is the first option to cure melanoma patients (PTS) at initial diagnosis, since primary cutaneous lesions are usually easily resectable. An excisional biopsy of the lesion, with minimal clear margins, can be obtained in the vast majority of cases. Punch biopsies may be proposed only in case of large lesions located on specific cosmetic or functional areas like the face, extremities, or genitals where a mutilating complete resection would not be performed without prior histological diagnosis. RECENT FINDINGS After the histologic confirmation of melanoma, definite surgical excision of the scar and surrounding tissue is planned, to obtain microsatellite free margins. The width of these margins has been identified following the results of several clinical trials and it is either 1 or 2 cm, depending on the Breslow thickness of the primary tumor. Following the latest staging system proposed by the American Joint Cancer commission (AJCC), a sentinel node biopsy (SNB) is usually performed in case of a primary lesion > 0.8 mm thickness or for high-risk thinner lesions, if no evidence of nodal involvement has been identified clinically or radiographically. Surgical management of primary melanoma is well established. There is debate on the optimal surgical margins for 1-2 mm melanomas. There are specific considerations for special primaries (bulky, extremity, mucosal). Sentinel node (SN) evaluation does not improve survival, but is routinely used as staging.
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Affiliation(s)
- Alessandro A E Testori
- Dermatology, Fondazione IRCCS policlinico San Matteo, Fondazione IRCCS San Matteo, Pavia, Italy.
| | - Stephanie A Blankenstein
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Alexander C J van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, Netherlands
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Christou N, Meyer J, Toso C, Ris F, Buchs NC. Lateral lymph node dissection for low rectal cancer: Is it necessary? World J Gastroenterol 2019; 25:4294-4299. [PMID: 31496614 PMCID: PMC6710187 DOI: 10.3748/wjg.v25.i31.4294] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/19/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
Rectal cancer constitutes a major public health issue. Total mesorectal excision has remained the gold standard treatment for mid and low rectal tumors since its introduction in the late 1980s. Removal of all lymph nodes located in the mesorectum has indeed improved pathological and oncological outcomes. However, when cancer spreads to the lateral lymph nodes (located along the iliac and obturator arteries) Western and Japanese practices differ. Where the Western guidelines consider this condition as an advanced form of the disease and use neoadjuvant radiochemotherapy liberally, the Japanese guidelines define it as a local disease and proceed to lateral lymph node dissection with or without neoadjuvant treatment. Herein, we review the current literature regarding both therapeutic strategies, with the aim of contributing to potential improvements in treatment and outcome for patients with low and mid rectal cancer.
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Affiliation(s)
- Niki Christou
- Service de Chirurgie Digestive, Endocrinienne et Générale, CHU de Limoges, Limoges Cedex 87042, France
- Division of Digestive Surgery, University Hospitals of Geneva, Genève 1211, Switzerland
- Unit of Surgical Research, University of Geneva, Genève 1206, Switzerland
| | - Jeremy Meyer
- Division of Digestive Surgery, University Hospitals of Geneva, Genève 1211, Switzerland
- Unit of Surgical Research, University of Geneva, Genève 1206, Switzerland
| | - Christian Toso
- Division of Digestive Surgery, University Hospitals of Geneva, Genève 1211, Switzerland
- Unit of Surgical Research, University of Geneva, Genève 1206, Switzerland
| | - Frédéric Ris
- Division of Digestive Surgery, University Hospitals of Geneva, Genève 1211, Switzerland
- Unit of Surgical Research, University of Geneva, Genève 1206, Switzerland
| | - Nicolas Christian Buchs
- Division of Digestive Surgery, University Hospitals of Geneva, Genève 1211, Switzerland
- Unit of Surgical Research, University of Geneva, Genève 1206, Switzerland
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Guevara M, Rodríguez-Barranco M, Puigdemont M, Minicozzi P, Yanguas-Bayona I, Porras-Povedano M, Rubió-Casadevall J, Sánchez Pérez MJ, Marcos-Gragera R, Ardanaz E. Disparities in the management of cutaneous malignant melanoma. A population-based high-resolution study. Eur J Cancer Care (Engl) 2019; 28:e13043. [PMID: 30993764 DOI: 10.1111/ecc.13043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/18/2019] [Accepted: 03/25/2019] [Indexed: 12/11/2022]
Abstract
Population-based cancer registry data from three Spanish areas were used to assess the patterns of care and adherence to guidelines for cutaneous malignant melanoma. We included 934 cases diagnosed in 2009-2013. Completeness of the pathology reports, imaging for detecting distant metastasis and the use of sentinel lymph node biopsy (SLNB) were analysed. The proportion of pathology reports that mentioned the essential pathological features required for T staging was 93%, ranging across geographic areas from 81% to 98% (p < 0.001). The percentage of low-risk patients who underwent no imaging studies, as proposed by guidelines, or only chest imaging ranged among areas from 0.6% to 84% (p < 0.001). Of the patients with clinically node-negative melanoma >1 mm thick and no distant metastases, 68% underwent SLNB, varying by area from 61% to 78% (p = 0.017). This study revealed wide geographic variation in different aspects of melanoma care. The use of a standardised structured pathology report could strengthen the completeness of reporting. Improvement strategies should also include efforts to reduce overuse of imaging in low-risk patients and to increase the adherence to guidelines recommendations on the use of SLNB.
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Affiliation(s)
- Marcela Guevara
- Navarra Public Health Institute - IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Miguel Rodríguez-Barranco
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Andalusian School of Public Health, Biomedical Research Institute of Granada (ibs.Granada), University of Granada, Granada, Spain
| | - Montse Puigdemont
- Epidemiology Unit and Girona Cancer Registry, Descriptive Epidemiology, Genetics and Cancer Prevention Group, IdIbGi, Catalan Institute of Oncology, Girona, Spain
| | - Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | | | - Jordi Rubió-Casadevall
- Medical Oncology Department, Catalan Institute of Oncology, Descriptive Epidemiology, Genetics and Cancer Prevention Group, IdIbGi, University of Girona, Girona, Spain
| | - María José Sánchez Pérez
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Andalusian School of Public Health, Biomedical Research Institute of Granada (ibs.Granada), University of Granada, Granada, Spain
| | - Rafael Marcos-Gragera
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Epidemiology Unit and Girona Cancer Registry, Descriptive Epidemiology, Genetics and Cancer Prevention Group, IdIbGi, Catalan Institute of Oncology, Girona, Spain
| | - Eva Ardanaz
- Navarra Public Health Institute - IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Odell DD, Feinglass J, Engelhardt K, Papastefan S, Meyerson SL, Bharat A, DeCamp MM, Bilimoria KY. Evaluation of adherence to the Commission on Cancer lung cancer quality measures. J Thorac Cardiovasc Surg 2019; 157:1219-1235. [PMID: 31343410 PMCID: PMC7382915 DOI: 10.1016/j.jtcvs.2018.09.126] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/23/2018] [Accepted: 09/29/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE In this study we present historic data on adherence to and survival outcomes associated with recently introduced quality measures for the management of non-small-cell lung cancer. METHODS The National Cancer Data Base was queried to identify all patients with non-small-cell lung cancer from 1998 to 2011. Adherence to guidelines was assessed for each of 3 Commission on Cancer-defined quality measures: (1) sampling 10 regional lymph nodes at surgery; (2a) surgery within 120 days of neoadjuvant chemotherapy or, (2b) 180 days of adjuvant chemotherapy; and (3) nonsurgical primary therapy in cN2 disease. The likelihood of measure adherence and the association of measure adherence with all-cause mortality were analyzed controlling for patient, hospital, and time period characteristics. RESULTS Regional lymph node sampling was inadequate in 72.7% of cases. Only 28.7% began adjuvant chemotherapy within 180 days of surgery. However, 96.5% of patients who received neoadjuvant chemotherapy proceeded to surgery within 120 days and surgery was first-line treatment for cN2 disease in only 3.7% of patients. Uninsured or Medicaid status was an independent risk factor for a prolonged delay between neoadjuvant chemotherapy and surgery (odds ratio, 1.36; 95% confidence interval, 1.08-1.72) and surgery and adjuvant treatment (odds ratio, 1.92; 95% confidence interval, 1.69-2.19). Overall survival was significantly better in patients whose care conformed to quality standards for nodal sampling (measure 1), and timing of chemotherapy. CONCLUSIONS Adherence rates for nodal sampling at the time of surgery and receipt of adjuvant chemotherapy were low. These findings highlight opportunities for improvement efforts, but more measures are needed to more broadly assess the quality of lung cancer care.
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Affiliation(s)
- David D Odell
- Northwestern Institute for Comparative Effectiveness Research in Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Division of Thoracic Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill.
| | - Joseph Feinglass
- Northwestern Institute for Comparative Effectiveness Research in Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Kathryn Engelhardt
- Northwestern Institute for Comparative Effectiveness Research in Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Steven Papastefan
- Northwestern Institute for Comparative Effectiveness Research in Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Division of Thoracic Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Shari L Meyerson
- Division of Thoracic Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Ankit Bharat
- Division of Thoracic Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Malcolm M DeCamp
- Northwestern Institute for Comparative Effectiveness Research in Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Division of Thoracic Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Karl Y Bilimoria
- Northwestern Institute for Comparative Effectiveness Research in Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Division of Surgical Oncology, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
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Lin L, Wang Z, Zeng X, Xu S, Ding Z, Cai J, Yuan S. [Feasibility analysis on membrane-based right-sided approach of laparoscopic suprapancreatic lymph node dissection for advanced distal gastric cancer]. Zhonghua Wei Chang Wai Ke Za Zhi 2018; 21:1142-1147. [PMID: 30370513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the feasibility and safety of membrane-based right-sided approach of laparoscopic suprapancreatic lymph node dissection for advanced distal gastric cancer. METHODS The clinical data of 41 patients with advanced distal gastric cancer who underwent laparoscopic gastrectomy using membrane-based right-sided approach for laparoscopic suprapancreatic lymph node dissection at the Department of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University from January 2016 to January 2018 were retrospectively analyzed. There were 24 males and 17 females with a mean age of 56.8 years and a mean body mass index of 22.6 kg/m². Membrane-based right-sided approach of laparoscopic suprapancreatic lymph node dissection contained 4 steps briefly: (1) dissection of mesenteria above the head of pancreas: the tri-junction of pancreas-duodenum was cut to expose and identify the logo of Benz;clearance of the membrane of No.5a was performed towards the left, and then expanded to the posterior layer of No.12a. (2) dissection of the V shape dorsal mesogastrium: membrane bridge at splenic artery trunk root was cut; in suprapancreatic space, clearance was performed towards to the left to the middle of the splenic artery trunk and expanded to the posterior Tolds plane upwards to the posterior phrenic angle and retroperitoneal esophagus, then the surrounding tissue of anterior abdominal aorta. (3) dissection of the U shape mesenteria:membrane bridge at common hepatic artery root was cut; mesentery was separated; the left gastric vein was freed and ligated at its root; in posterior pancreatic space, the mesentery of No.7, No.9 and No.8 was dissected in turns; the left gastric artery was high ligated and cut; the portal vein and posterior dorsal mesogastrium Toldt plane was routinely exposed; clearance was performed to right for No.8a and upward to the hepatic portal meeting at posterior mesentery No.12 plane. (4) dissection of the upper triangular area of pylorus: the trigone mesentery was cut along the upper edge of the pylorus; No.12a was swept upward along the gastric ventral mesentery; the upper boundary(No.8a) on the right side of the U-shaped membrane was joined. Intraoperative and postoperative presentations were analyzed. RESULTS Laparoscopic gastrectomy for advanced distal gastric cancer with membrane-based right-sided approach of laparoscopic suprapancreatic lymph node dissection was successfully carried out in all the 41 patients. Distal gastric mesenteria en bloc resection was successfully performed. The operation time was (145.2±25.4) minutes and intraoperative blood loss was (53.3±18.3) ml without massive bleeding and severe complication. Number of lymph nodes dissected was 41.1±6.4, and number of suprapancreatic lymph node dissected was 23.3±3.7 without residual cancer at cut margin by pathology. Postoperative drainage volume was (65.8±21.7) ml; time to withdraw of catheter was (7.0±1.7) days; time to fluid intake was (3.5±1.8) days; postoperative hospital stay was (10.4±2.8) days; time to postoperative anal exhaust was (3.3±1.1) days. No complications, such as chyle leakage, postoperative massive bleeding, anastomotic leakage, abdominal cavity infection or gastroplegia occurred within 30 days after surgery. CONCLUSION Membrane-based right-sided approach of laparoscopic suprapancreatic lymph node dissection for advanced distal gastric cancer can achieve en bloc resection and conform to the radical principle of oncology, and is safe and feasible.
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Affiliation(s)
- Li Lin
- Department of Gastrointestinal Surgery, Institute of Gastrointestinal Oncology of Xiamen University School of Medicine, Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Zhongshan Hospital, Xiamen University, Xiamen 361004, China
| | - Zhenfa Wang
- Department of Gastrointestinal Surgery, Institute of Gastrointestinal Oncology of Xiamen University School of Medicine, Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Zhongshan Hospital, Xiamen University, Xiamen 361004, China
| | - Xuehui Zeng
- Department of Gastrointestinal Surgery, Institute of Gastrointestinal Oncology of Xiamen University School of Medicine, Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Zhongshan Hospital, Xiamen University, Xiamen 361004, China
| | - Shuzhen Xu
- Department of Gastrointestinal Surgery, Institute of Gastrointestinal Oncology of Xiamen University School of Medicine, Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Zhongshan Hospital, Xiamen University, Xiamen 361004, China
| | - Zhijie Ding
- Department of Gastrointestinal Surgery, Institute of Gastrointestinal Oncology of Xiamen University School of Medicine, Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Zhongshan Hospital, Xiamen University, Xiamen 361004, China
| | - Jianchun Cai
- Department of Gastrointestinal Surgery, Institute of Gastrointestinal Oncology of Xiamen University School of Medicine, Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Zhongshan Hospital, Xiamen University, Xiamen 361004, China
| | - Sibo Yuan
- Department of Gastrointestinal Surgery, Institute of Gastrointestinal Oncology of Xiamen University School of Medicine, Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Zhongshan Hospital, Xiamen University, Xiamen 361004, China
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Lu W, Zeng X, Li N, Liu H. [Clinical value of superior mesenteric vein (No.14v) lymph node dissection in D2 gastrectomy for locally advanced distal gastric cancer]. Zhonghua Wei Chang Wai Ke Za Zhi 2018; 21:1136-1141. [PMID: 30370512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To explore the value of superior mesenteric vein (No.14v) lymph node dissection in D2 gastrectomy for locally advanced distal gastric cancer. METHODS A retrospective cohort study was carried out. A total of 796 patients with locally advanced distal gastric cancer undergoing D2 gastrectomy at the Cancer Center of Guangzhou Medical University between 2002 and 2016 were enrolled. INCLUSION CRITERIA locally advanced distal gastric adenocarcinoma confirmed by postoperative pathology; adenocarcinoma located at or invaded into lower 1/3 stomach; lymphadenectomy was D2 or D2+; negative resection margin confirmed by pathology; no distal metastasis was found; preoperative neoadjuvant chemotherapy was not administrated. Patients with undefined group of lymph nodes by postoperative pathology and those who were died perioperatively were excluded. Among 796 patients, 293 underwent No.14v dissection (No.14vD+ group) and the other 503 patients did not undergo No.14v dissection (No.14vD- group). The 5-year overall survival was compared between the two groups. Therapeutic index of No.14v lymph nodes was calculated according to the following formula: therapeutic index=metastatic rate of No.14 lymph nodes (%) × 5-year survival rate of patients with No.14 lymph node metastasis(%) × 100. Meanwhile, stratified analyses based on pathological TNM staging were performed. RESULTS There were no significant differences in age, gender, tumor size, Borrmann type, Lauren classification, histological type, surgical procedure, and number of harvested lymph node between two groups (all P>0.05). However, compared to No.14vD- group, No.14vD+ group had more advanced T staging (χ² =14.771, P=0.005) and TNM staging (χ² =18.339, P=0.003), and higher ratio of receiving adjuvant chemotherapy (χ² =4.205, P=0.040). The median follow-up period was 47 months. The 5-year survival rate in No.14vD+ and No.14vD- groups was 57.4% and 46.8% respectively without statistically significant difference (P=0.313). After adjusting for confounding factors, Cox proportional hazards model showed that No.14v lymphadenectomy was not an independent prognostic factor(HR=0.802, 95%CI: 0.545-1.186, P=0.124). Stratified analyses revealed that in all TNM stages, 5-year survival rates were not significantly different between two groups (all P>0.05). However, No.14v lymphadenectomy showed a tendency of survival benefit when the tumor staging after advancing to III A stage(III A: P=0.103; III B: P=0.085; III C: P=0.060). Five-year survival rates of No.14vD+ and No.14vD- groups in stage III A were 54.9% and 45.2%, in III B stage were 39.8% and 29.5%, in III C stage were 27.5% and 16.2%, respectively. After combining III A, III B and III C, the No.14vD+ group had a higher 5-year survival rate than No.14vD- group (39.2% vs. 27.7%, P=0.006). The No.14v metastasis rate in No14v+ group was 12.6%(37/293), including 0%(0/46), 2.5%(1/40), 4.9%(2/41), 15.7%(8/51), 20.8%(11/53) and 24.2%(15/62) in stages I B, II A, II B, III A, III B and III C respectively. The metastasis rate of No.14v lymph node in stage III patients was 20.5%(34/166). The 5-year survival rate of these 34 stage III patients with No.14v metastasis was 21.1%. The therapeutic index of No.14v lymph node in stage III patients was 4.3, which was comparable with 3.9 of No.9 and 4.9 of No.11p, even higher than 2.6 of No.1. CONCLUSIONS Although No.14v lymphadenectomy can not improve the overall survival of patients with locally advanced distal gastric cancer, but it may significantly improve survival in those with stage III cancer. The therapeutic index of No.14v lymph node is similar to No.2 station lymph node in patients with stage III distal gastric cancer. Therefore No.14v lymph node should be included in D2 dissection.
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Affiliation(s)
- Weiqun Lu
- Department of Gastrointestinal Surgery, Cancer Center of Guangzhou Medical University, Guangzhou 510095, China
| | - Xiang Zeng
- Department of Gastrointestinal Surgery, Cancer Center of Guangzhou Medical University, Guangzhou 510095, China
| | - Nan Li
- Department of Gastrointestinal Surgery, Cancer Center of Guangzhou Medical University, Guangzhou 510095, China
| | - Haiying Liu
- Department of Gastrointestinal Surgery, Cancer Center of Guangzhou Medical University, Guangzhou 510095, China
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Malek KS, Namm JP, Garberoglio CA, Senthil M, Solomon N, Reeves ME, Lum SS. Attending Surgeon Variation in Operative Case Length: An Opportunity for Quality Improvement. Am Surg 2018; 84:1595-1599. [PMID: 30747676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Balancing resident education with operating room (OR) efficiency, while accommodating different styles of surgical educators and learners, is a challenging task. We sought to evaluate variability in operative time for breast surgery cases. Accreditation Council for Graduate Medical Education case logs of breast operations from 2011 to 2017 for current surgical residents at Loma Linda University were correlated with patient records. The main outcome measure was operative time. Breast cases were assessed as these operations are performed during all postgraduate years (PGY). Breast procedures were grouped according to similarity. Variables analyzed included attending surgeon, PGY level, procedure type, month of operation, and American Society of Anesthesiologists class. Of 606 breast cases reviewed, median overall operative time was 150 minutes (interquartile range 187-927). One-way analysis of covariance demonstrated statistically significant variation in operative time by attending surgeon controlling for covariates (PGY level, procedure, American Society of Anesthesiologists class, and month) (P = 0.04). With institutional OR costs of $30 per minute, the average difference between slowest and fastest surgeon was $2400 per case [(218-138) minutes × $30/min]. Minimizing variability for common procedures performed by surgical educators may enhance OR efficiency. However, the impact of case length on surgical resident training requires careful consideration.
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Carman K, Gretschel A, Frank R, Dove J, Bannon JP, Protyniak B, Erchinger T, Chu K, Oxenberg J. Improvement in Pathology Lymph Node Harvesting Guideline Adherence for Colorectal Cancer. Am Surg 2018; 84:e279-e281. [PMID: 30841999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Hoyos S, Navas MC, Restrepo JC, Botero RC. Current controversies in cholangiocarcinoma. Biochim Biophys Acta Mol Basis Dis 2018; 1864:1461-1467. [PMID: 28756216 DOI: 10.1016/j.bbadis.2017.07.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 12/13/2022]
Abstract
Cholangiocarcinoma represents 10% of primary liver malignancies and accounts for less than 3% of all gastrointestinal malignant tumors, with an enormous geographical variation. This neoplasia can arise from the biliary tract epithelium or hepatic progenitor cells. Depending on the anatomic localization, it is classified into three subtypes: intrahepatic, perihilar and distal. This fact is one of the main difficulties, because there are many studies that indistinctly include the results in the management of these different types of cholangiocarcinoma, without differentiating its location and even including gallbladder cancer. There are many controversial points in epidemiology, liver transplantation as a treatment, limitations of different results by group and type of treatment, histological testing and chemotherapy. This is a narrative review about topics in cholangiocarcinoma. This article is part of a Special Issue entitled: Cholangiocytes in Health and Disease edited by Jesus Banales, Marco Marzioni, Nicholas LaRusso and Peter Jansen.
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Affiliation(s)
- Sergio Hoyos
- Hepatobiliary and Liver Transplant Program, Hospital Pablo Tobon Uribe-Universidad de Antioquia, Medellín, Colombia; Grupo Gastrohepatologia, Facultad de Medicina, Universidad of Antioquía UdeA, Calle 70 No. 52-21, Medellin, Colombia; Epidemiology, University CES, Medellin, Colombia.
| | - Maria-Cristina Navas
- Grupo Gastrohepatologia, Facultad de Medicina, Universidad of Antioquía UdeA, Calle 70 No. 52-21, Medellin, Colombia
| | - Juan-Carlos Restrepo
- Hepatobiliary and Liver Transplant Program, Hospital Pablo Tobon Uribe-Universidad de Antioquia, Medellín, Colombia; Grupo Gastrohepatologia, Facultad de Medicina, Universidad of Antioquía UdeA, Calle 70 No. 52-21, Medellin, Colombia
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Zhao S, Ma D, Huang Y, Zhang L, Cao Y, Wang Y. STARD: How many lymph nodals needed to be dissected in corpus carcinoma? Medicine (Baltimore) 2018; 97:e0260. [PMID: 29668578 PMCID: PMC5916645 DOI: 10.1097/md.0000000000010260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
During corpus carcinoma surgery, there is uncertainty as to how many lymph nodes should be dissected and examined to determine lymph invasion.In this study, we evaluated a beta-binominal model in data extracted from the Surveillance, Epidemiology, and End Results (SEER) database, which contains 22,372 complete records. We quantified the relationship between examined node number and the probability of missing invaded nodes. Survival curves were used for further validation.We found that for stage T1-T4, 1, 10, 23, and 37 lymph nodes, respectively, needed to be examined to minimize the missing positive nodal probability (1-nodal staging score, NSS) to less than 5%. A hypothetical lymph node examination rate was calculated. Survival rate of T2 and T3 stage samples was significantly associated with NSS, but T1 and T4 sample survival rate was not.The currently dissected nodal should be reduced to 1 to 2 for T1, remains to 10 for T2, and increases to 23 for T3.
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Affiliation(s)
- Shuping Zhao
- Qingdao Women and Children Binomial Model from the SEER Database Strict
| | - Dehua Ma
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Yu Huang
- Qingdao Women and Children Binomial Model from the SEER Database Strict
| | - Lei Zhang
- Qingdao Women and Children Binomial Model from the SEER Database Strict
| | - Yuan Cao
- Qingdao Women and Children Binomial Model from the SEER Database Strict
| | - Yawen Wang
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
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15
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Afifi R, Person B, Haddad R. The Impact of Surgeons: Pathologists Dialog on Lymph Node Evaluation of Colorectal Cancer Patients. Isr Med Assoc J 2018; 20:30-33. [PMID: 29658204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Lymph node (LN) retrieval and assessment is essential for accurate staging and treatment planning in colorectal cancer (CRC). According to U.S. National Cancer Institute recommendations, the minimal number of LNs needed for accurately staging of node-negative CRC is 12. Awareness and implementation of the guidelines has been shown to improve after assigning an opinion leader who has a special interest in CRC. OBJECTIVES To evaluate the impact of dialogue between surgeons and pathologists in LN evaluation. METHODS Consecutively treated CRC patients at the Department of Surgery B at Rambam Medical Center from January 1, 2000 through July 30, 2005 were identified from hospital discharge files. Demographic, surgical, and pathological data were extracted. Patients were divided into two groups. Group I patients underwent surgery before the initiation of a structured surgical oncology service (January 1, 2000 to October 30, 2004). Group II patients underwent surgery after the initiation of the service (November 1, 2004 to July 30, 2005). RESULTS The study comprised 212 patients (Group I: n=170; Group II: n=42). The median number of LNs examined was 9 in Group I and 14 in Group II (P = 0.003). Only 35% of patients in Group I received adequate LN evaluation compared to 79% in Group II (P = 0.0001). Patients with left-sided or rectal cancer were less likely to receive adequate LN evaluation than patients with right-sided cancers. CONCLUSIONS A durable improvement in LN evaluation was realized through a multi-pronged change initiative aimed at both surgeons and pathologists.
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Affiliation(s)
- Rana Afifi
- Department of Surgery B, Rambam Medical Center, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Benjamin Person
- Department of Surgery B, Rambam Medical Center, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Riad Haddad
- Department of Surgery B, Rambam Medical Center, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Surgery B, Carmel Medical Center, Haifa, Israel
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Okholm C, Fjederholt KT, Mortensen FV, Svendsen LB, Achiam MP. The optimal lymph node dissection in patients with adenocarcinoma of the esophagogastric junction. Surg Oncol 2017; 27:36-43. [PMID: 29549902 DOI: 10.1016/j.suronc.2017.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/18/2017] [Accepted: 11/22/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The aim of this study was to refine the optimal lymph node dissection in Western patients with adenocarcinoma of the esophagogastric junction (AEG). BACKGROUND Lymphadenectomy is essential in addition to surgery for AEG. Asian studies continually present superior survival rates using a more extended lymphadenectomy compared with results reproduced in the West. Thus, the optimal extend of the lymphadenectomy remains unclear in Western patients. METHODS A retrospective cohort was conducted of patients with AEG from January 1st, 2003 to December 31st, 2011. All patients undergoing curatively intended surgery was included. Two types of resections were constructed; Res1 included patients where only the loco regional lymph nodes were removed (station 1-4, 7 and 9) and Res2 included the additional removal of the more distant stations 8 and/or 11. RESULTS We identified 510 patients with AEG. The highest frequency of lymph node metastases was seen in the loco regional stations 1-3, 7 and 9, ranging from 34% to 41.4%. There was no difference in overall survival between the two groups; the median survival rate for Res1 was 30.4 months compared to 24.1 months for Res2 (p = 0.157). Furthermore, the extend of lymph node dissection seemed to have no effect on survival (HR = 1.061, 95%CI 0.84-1.33). CONCLUSION No significant difference in survival between the extended and the less extended lymphadenectomy was found. The presence of metastases in distant lymph nodes indicates poor survival and may represent disseminated disease. We do not find evidence that supports an extended lymph node dissection in Western patients.
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Affiliation(s)
- Cecilie Okholm
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, Denmark.
| | - Kaare Terp Fjederholt
- Department of Surgery, Section for Upper Gastrointestinal and Hepato-pancreato-biliary urgery, Aarhus University Hospital, Denmark
| | - Frank Viborg Mortensen
- Department of Surgery, Section for Upper Gastrointestinal and Hepato-pancreato-biliary urgery, Aarhus University Hospital, Denmark
| | - Lars Bo Svendsen
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, Denmark
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Weiss A, Mittendorf EA, DeSnyder SM, Hwang RF, Bea V, Bedrosian I, Hoffman K, Adrade B, Sahin AA, Kuerer HM, Hunt KK, Caudle AS. Expanding Implementation of ACOSOG Z0011 in Surgeon Practice. Clin Breast Cancer 2017; 18:276-281. [PMID: 29100726 DOI: 10.1016/j.clbc.2017.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/11/2017] [Accepted: 10/06/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND After publication of American College of Surgeons Oncology Group (ACOSOG) Z0011, surgeons at our institution limited axillary surgery to sentinel lymph node dissection (SLND) in 76% of patients meeting trial eligibility criteria. Our study objective was to assess incorporation of the trial data into practice 5 years later. PATIENTS AND METHODS Patients with clinical T1-2, N0 invasive breast cancer undergoing breast conserving surgery were included. Comparisons were made between patients who underwent axillary lymph node dissection (ALND) and those that had no further surgery. RESULTS A total of 396 patients were included. Twelve percent (48/396) had positive SLNs; ALND was performed in 8% (4/48). Patients who underwent ALND were more likely to have 2 positive SLNs (50%, 2/4 vs. 2%, 1/44; P = .02) and microscopic extranodal extension (75%, 3/4 vs. 18%, 8/44; P = .03) than those that did not undergo ALND. Patients who underwent ALND also had a higher nomogram-predicted probability of having additional positive non-SLNs (53%) than those who had SLND alone (22%) (P = .0002). No patients had intraoperative assessment of SLNs performed. CONCLUSIONS The practice of omitting ALND in ACOSOG Z0011-eligible patients has expanded over 5 years. Clinicopathologic features continue to impact this decision. Intraoperative SLN assessment is no longer performed.
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Affiliation(s)
- Anna Weiss
- Department of Surgical Oncology, Brigham and Women's Hospital, Boston, MA
| | - Elizabeth A Mittendorf
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sarah M DeSnyder
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rosa F Hwang
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vivian Bea
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Isabelle Bedrosian
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Karen Hoffman
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Beatriz Adrade
- Department of Breast Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Aysegul A Sahin
- Department of Pathology Administration, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Henry M Kuerer
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Abigail S Caudle
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
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Lyu Z, Wang J, Li Y. [Discussion on standardized implementation of laparoscopic radical lymphadenectomy for distal gastric cancer]. Zhonghua Wei Chang Wai Ke Za Zhi 2017; 20:857-861. [PMID: 28836242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Laparoscopic radical gastrectomy for gastric cancer has been widely applied in clinical practice, and its indications have been extended from early gastric cancer to advanced gastric cancer. It is acknowledged that laparoscopic radical gastrectomy is technically challenging because of the complexity of anatomy, rich blood supply, and extensive lymph node dissection. This paper primarily intends to share the experience of laparoscopic radical D2 gastrectomy for distal gastric cancer with details of choosing the location of Trocar, surgical approaches and the sequence of lymph node dissection. All the surgeries were performed at Department of General Surgery and Gastrointestinal Surgery, Guangdong General Hospital. The finding suggests that a correct laparoscopic Trocar placement is the foundation of adequate surgical field visualization. Under most circumstances, the observation hole should be around 2 cm below the umbilicus and the operating hole should be close to the bilateral clavicle midline. Furthermore, proper surgical approach and sequence of lymph node dissection are the prerequisites for successful laparoscopic radical D2 gastrectomy, as well as the reassurance of dissecting lymph node safely and comprehensively. The position of surgical team adopted in our center is that the surgeon stands to the left of the patient, with laparoscope operator stands in between patient's legs while the first assistant positions himself opposite the surgeon on the right side of the patient. This position correlates to the rules of sequential lymph node dissection, which is "from left to right", "from proximal to distal" and "from inferior to superior". Therefore, it is conductive to inferior and superior pylorus region dissection and it can effectively prevent subsidiary-injury. In our center, the procedure of lymph node dissection has been standardized: the initial step is to undergo station 4sb dissection and greater gastric curvature clearance; then change the patient's position to clean the sub-pyloric lymph node region and cut off the duodenum by linear stapler; followed by the clearance of inferior region of the pylorus and the upper margin of the pancreas; in the final step, the first and the third groups of lymph node dissection is performed. Although varied surgical approaches and sequences of lymph node dissection are applied in different hospitals, the techniques required for laparoscopic D2 radical gastrectomy for gastric cancer are sophisticated and advanced in general. Radical lymph node dissection is complicated, urging surgeons to familiarize themselves with the anatomy of gastric peripheral vascular system and characteristics of lymph node drainage. By designing and implementing effective strategies, such as formulating a regular team, positioning surgical team reasonably, changing a patient's posture during operation, choosing an appropriate surgical approach and following a logically sequence of lymph node dissection, surgeons can standardize the complete surgical procedure, which ultimately reduces bleeding during surgery and shortens the operative time.
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Affiliation(s)
| | | | - Yong Li
- Department of Gastrointestinal Surgery, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou 510080, China.
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Liang H. [Quality control of radical lymphadenectomy for gastric cancer]. Zhonghua Wei Chang Wai Ke Za Zhi 2017; 20:726-730. [PMID: 28722081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
D2 lymphadenectomy is currently the worldwide standard operation for locally advanced gastric cancer. There were no major modifications for extent of standard lymphadenectomy in Japanese gastric cancer treatment guidelines 2014(ver.4). Prophylactic para-arotic lymphadenectomy is not recommended. Although there is no high level evidence, D2+No14v may be beneficial to patients who are suspected to harbor metastasis to No6 node, and D2+No13 lymphadenectomy may be an option in a potentially curative gastrectomy for tumors invading the duodenum. According to the finial results of JCOG1001, bursectomy is not recommended as a standard procedure for cT3/4 gastric cancer. Incidence of gastric cancer is quite high in China while overall operation level of gastric cancer is unequal. How to ensure the quality of radical gastrectomy is a recently important topic meanwhile the lymphadenectomy extent should be standard. Operational quantity per year in hospital and surgeons is considered as the final factors for the quality of radical gastrectomy. Centralization of gastric cancer surgery may be needed for the improvement of gastric cancer care in China. Education and training for the specialist are imperative for good outcomes of gastric cancer surgery. Ex vivo dissection for lymph nodes is effective method of precise staging and individual adjuvant treatment for gastric cancer patients.
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Affiliation(s)
- Han Liang
- Department of Gastric Cancer Surgical, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China.
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Rossi E. Point/Counterpoint: Is Lymphadenectomy Required in Endometrial Cancer for Adequate Surgical Staging? Oncology (Williston Park) 2017; 31:390-401. [PMID: 28516438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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21
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Multinu F, Casarin J, Mariani A. Point/Counterpoint: Is Lymphadenectomy Required in Endometrial Cancer for Adequate Surgical Staging? Oncology (Williston Park) 2017; 31:390-401. [PMID: 28516437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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22
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Leyh-Bannurah SR, Budäus L, Pompe R, Zaffuto E, Briganti A, Abdollah F, Montorsi F, Schiffmann J, Menon M, Shariat SF, Fisch M, Chun F, Huland H, Graefen M, Karakiewicz PI. North American Population-Based Validation of the National Comprehensive Cancer Network Practice Guideline Recommendation of Pelvic Lymphadenectomy in Contemporary Prostate Cancer. Prostate 2017; 77:542-548. [PMID: 28093788 DOI: 10.1002/pros.23292] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 11/30/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND National Comprehensive Cancer Network (NCCN) guidelines recommend a pelvic lymph node dissection (PLND) in prostate cancer (PCa) patients treated with radical prostatectomy (RP) if a nomogram predicted risk of lymph node invasion (LNI) is ≥2%. We examined this and other thresholds, including nomogram validation. METHODS We examined records of 26,713 patients treated with RP and PLND between 2010 and 2013, within the Surveillance, Epidemiology, and End Results database. Nomogram thresholds of 2-5% were tested and external validation was performed. RESULTS LNI was recorded in 4.7% of patients. Nomogram accuracy was 80.4% and maintained minimum accuracy of 75.6% in subgroup analyses, according to age, race, and nodal yield >10. With the NCCN recommended 2% nomogram threshold, PLND could be avoided in 22.3% of patients at the expense of missing 3.0% of individuals with LNI. Alternative thresholds of 3%, 4%, and 5% yielded respective PLND avoidance rates of 60.4%, 71.0%, and 79.8% at the expense of missing 17.8%, 27.2%, and 36.6% of patients with LNI. NCCN cut-off recommendation was best satisfied with a threshold of <2.6%, at which PLND could be avoided in 13,234 patients (49.5%) versus missing 141 patients with LNI (11.2%). CONCLUSION NCCN LNI nomogram remains accurate in contemporary patients. However, the 2% threshold appears to be too strict, since only 22.3% of PLNDs can be avoided, instead of the stipulated 47.7%. The optimal 2.6% threshold allows a higher rate of PLND avoidance (49.5%), at the cost of 11.2% missed instances of LNI, as recommended by NCCN guidelines. PATIENT SUMMARY. External validation in contemporary SEER prostate cancer patients showed that the NCCN nomogram remains accurate for predicting lymph node invasion and seems to be optimal at an alternative 2.6% threshold, with best ratio of avoided pelvic lymph node dissections (49.5%) and missed LNIs (11.2%), as recommended by NCCN guideline. Prostate 77:542-548, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Sami-Ramzi Leyh-Bannurah
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Budäus
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Raisa Pompe
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Emanuele Zaffuto
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Firas Abdollah
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Jonas Schiffmann
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Mani Menon
- Vattikuti Urology Institute and VUI Center for Outcomes Research Analytics and Evaluation (VCORE), Henry Ford Health System, Henry Ford Hospital, Detroit, Michigan
| | | | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix Chun
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hartwig Huland
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
- Department of Urology, University of Montreal Health Center, Montreal, Canada
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Mao Y, Yang D, Gao S, Xue Q, He J. [Consensus and controversies of surgical approach selection in the treatment for thoracic esophageal cancers]. Zhonghua Wei Chang Wai Ke Za Zhi 2016; 19:961-964. [PMID: 27680059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Esophageal cancer is one of the most prevalent carcinoma with an incidence ranking at the fifth and the mortality at the fourth among all the carcinomas in China. Up to now, surgery-based multi-modality treatment is still the most effective treatment for esophageal carcinoma. The surgical approaches for esophageal cancer include left and right thoracic approaches. Esophagectomy through left thoracotomy is the earliest approach applied for esophageal cancer in China, and now is still used frequently for esophageal cancer in northern China. However, left thoracic approach is insufficient in the lymph node dissection for superior mediastinum and abdomen, especially for the tracheoesophageal groove and para-recurrent laryngeal nerve nodes. On the contrary, right thoracic approach can achieve complete thoracic and abdominal field(two-field) lymph node dissection, especially the tracheoesophageal groove and para-recurrent laryngeal nerve nodes, which may eventually improve the survival of the patients with esophageal cancer. This article summarizes the results of lymph node dissection and prognosis based on published literatures through left thoracic approach versus through right thoracic approach for esophageal cancer, comments on recent controversies and consensus: for resectable thoracic esophageal carcinoma, resection of thoracic esophageal carcinoma with 2-field or 3-field lymph node dissection through right thoracic approach should be recommended as the major treatment mode, but this consensus was made based on retrospective studies, and the evidence is only level III(, therefore, prospective randomized studies with larger sample size are warranted. The selection of surgical approach for the lower thoracic esophageal cancer patients without upper mediastinal lymph node enlargement is also the direction of future clinical trials.
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Affiliation(s)
| | | | | | | | - Jie He
- Department of Thoracic Surgery, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
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Wahl AO, Gaffney DK, Jhingran A, Yashar CM, Biagioli M, Elshaikh MA, Jolly S, Kidd E, Lee LJ, Li L, Moore DH, Rao GG, Williams NL, Small W. ACR Appropriateness Criteria® Adjuvant Management of Early-Stage Endometrial Cancer. Oncology (Williston Park) 2016; 30:816-822. [PMID: 27633412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
These consensus guidelines on adjuvant radiotherapy for early-stage endometrial cancer were developed from an expert panel convened by the American College of Radiology. The American College of Radiology Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method; and Grading of Recommendations Assessment, Development, and Evaluation, or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. After a review of the published literature, the panel voted on three variants to establish best practices for the utilization of imaging, radiotherapy, and chemotherapy after primary surgery for early-stage endometrial cancer.
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Mrena J, Mattila A, Böhm J, Jantunen I, Kellokumpu I. Surgical care quality and oncologic outcome after D2 gastrectomy for gastric cancer. World J Gastroenterol 2015; 21:13294-13301. [PMID: 26715812 PMCID: PMC4679761 DOI: 10.3748/wjg.v21.i47.13294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/17/2015] [Accepted: 10/26/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To examine the quality of surgical care and long-term oncologic outcome after D2 gastrectomy for gastric cancer.
METHODS: From 1999 to 2008, a total of 109 consecutive patients underwent D2 gastrectomy without routine pancreaticosplenectomy in a multimodal setting at our institution. Oncologic outcomes together with clinical and histopathologic data were analyzed in relation to the type of surgery performed. Staging was carried out according to the Union for International Cancer Control criteria of 2002. Patients were followed-up for five years at the outpatient clinic. The primary measure of outcome was long-term survival with the quality of surgery as a secondary outcome measure. Clinical data were retrospectively collected from the patient records, and causes of death were obtained from national registries.
RESULTS: A total of 109 patients (58 men) with a mean age of 67.4 ± 11.2 years underwent total gastrectomy or gastric resection with D2 lymph node dissection. The tumor stage distribution was as follows: stage I, (27/109) 24.8%; stage II, (31/109) 28.4%; stage III, (41/109) 37.6%; and stage IV, (10/109) 9.2%. Forty patients (36.7%) received chemotherapy or chemoradiotherapy. The five-year overall survival rate for all 109 patients was 45.0%, and was 47.1% for the 104 patients treated with curative R0 resection. The five-year disease-specific survival rates were 53.0% and 55.8%, respectively. In a multivariate analysis, body mass index and tumor stage were independent prognostic factors for overall survival (both P < 0.01), whereas body mass index, tumor stage, tumor site, Lauren classification, and lymph node invasion were prognostic factors for cancer-specific survival (all P < 0.05). Postoperative 30-d mortality was 1.8% and 30-d, surgical (including three anastomotic leaks, two of which were treated conservatively), and general morbidities were 26.6%, 12.8%, and 14.7%, respectively.
CONCLUSION: D2 dissection is a safe surgical option for gastric cancer, providing quality surgical care and long-term oncologic outcomes that are in line with current Western standards.
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Gravante G, Parker R, Elshaer M, Mogekwu AC, Humayun N, Thomas K, Thomson R, Hudson S, Sorge R, Gardiner K, Al-Hamali S, Rashed M, Kelkar A, El-Rabaa S. Lymph node retrieval for colorectal cancer: Estimation of the minimum resection length to achieve at least 12 lymph nodes for the pathological analysis. Int J Surg 2015; 25:153-7. [PMID: 26713777 DOI: 10.1016/j.ijsu.2015.12.062] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/15/2015] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Adequate lymph node retrieval is important in colorectal cancer staging for the selection of patients that necessitate adjuvant treatments. The minimum number of 12 lymph nodes is one of the premises and is dependent, among the other factors, from the length of bowel resected. We have reviewed our specimens to identify the high-risk operations for inadequate nodal sampling and estimate the minimum length of bowel needed to resect to achieve this purpose. MATERIALS AND METHODS A retrospective review of colorectal specimens over 10 years of activity looking at data including location of the tumor, type of operation performed, length of bowel resected and number of lymph nodes retrieved. RESULTS Abdominoperineal and Hartmann's resections produced significant lower adequate retrievals compared to other colorectal operations, corresponding to 45.4% and 59.1% of cases respectively. The measured average length of bowel was 30 cm and 25 cm respectively, increasing the length to 36 cm and 42 cm would increase the adequacy rate to 90%. CONCLUSIONS Abdominoperineal and Hartmann's resections are, in our series, high-risk operations that frequently do not produce the minimum number of lymph nodes necessary. These operations may require additional maneuvers such as mobilization of the splenic flexure to achieve the minimum length of bowel to resect.
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Affiliation(s)
- Gianpiero Gravante
- Department of Surgery, Kettering General Hospital, Kettering, United Kingdom
| | - Rupert Parker
- Department of Surgery, Kettering General Hospital, Kettering, United Kingdom
| | - Mohamed Elshaer
- Department of Surgery, West Hertfordshire Hospitals, Watford, United Kingdom.
| | | | - Nada Humayun
- Department of Surgery, Kettering General Hospital, Kettering, United Kingdom
| | - Katie Thomas
- Department of Surgery, Kettering General Hospital, Kettering, United Kingdom
| | - Rachael Thomson
- Department of Surgery, Kettering General Hospital, Kettering, United Kingdom
| | - Sarah Hudson
- Department of Surgery, Kettering General Hospital, Kettering, United Kingdom
| | - Roberto Sorge
- Department of Human Physiology, Laboratory of Biometry, University of Tor Vergata, Rome, Italy
| | - Katy Gardiner
- Department of Surgery, Kettering General Hospital, Kettering, United Kingdom
| | - Salem Al-Hamali
- Department of Surgery, Kettering General Hospital, Kettering, United Kingdom
| | - Mohamed Rashed
- Department of Surgery, Kettering General Hospital, Kettering, United Kingdom
| | - Ashish Kelkar
- Department of Surgery, Kettering General Hospital, Kettering, United Kingdom
| | - Saleem El-Rabaa
- Department of Surgery, Kettering General Hospital, Kettering, United Kingdom
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Lairmore TC, Diesen D, Goldfarb M, Milas M, Ying AK, Sharma J, McIver B, Wong RJ, Randolph G. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY DISEASE STATE CLINICAL REVIEW: TIMING OF MULTIPLE ENDOCRINE NEOPLASIA THYROIDECTOMY AND EXTENT OF CENTRAL NECK LYMPHADENECTOMY. Endocr Pract 2015; 21:839-47. [PMID: 26172129 DOI: 10.4158/ep14463.dscr] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Kim WR, Han YD, Cho MS, Hur H, Min BS, Lee KY, Kim NK. Oncologic Impact of Fewer Than 12 Lymph Nodes in Patients Who Underwent Neoadjuvant Chemoradiation Followed by Total Mesorectal Excision for Locally Advanced Rectal Cancer. Medicine (Baltimore) 2015; 94:e1133. [PMID: 26181550 PMCID: PMC4617087 DOI: 10.1097/md.0000000000001133] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
A minimum of 12 harvested lymph nodes (hLNs) are recommended in colorectal cancer. However, a paucity of hLNs is frequently presented after preoperative chemoradiation (pCRT) in rectal cancer and the significance of this is still uncertain. The aim of this study is to analyze the impact of hLNs on long-term oncologic outcomes. A total of 302 patients with locally advanced rectal cancer who underwent pCRT and curative resection between 1989 and 2009 were reviewed. Patients were categorized into 2 groups according to the number of hLNs: <12 versus ≥12 LN. The 2 groups were compared with respect to 5-year disease-free and overall survival. The optimal number or ratio of hLNs was investigated in subgroup analysis according to LN status. The median follow-up was 57 months. Patient characteristics other than age did not differ between the 2 groups. The group with <12 LNs had more favorable ypTNM and ypN stage than those with ≥12 LNs. However, the long-term oncologic outcomes were not significantly different between the 2 groups. In subgroup analysis of ypN(-), the group with <5 hLNs had the most favorable oncologic outcomes. In ypN(+) cases, a higher LN ratio tended to be associated with poorer 5-year overall survival. The paucity of hLNs in locally advanced rectal cancer after chemoradiation did not imply poor oncologic outcomes in this study. In addition, <5 hLNs in ypN(-) patients could reflect a good tumor response rather than suboptimal radicality.
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Affiliation(s)
- Woo Ram Kim
- From the Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Feo CV, Portinari M, Zuolo M, Targa S, Matarese VG, Gafà R, Forini E, Lanza G. Preoperative endoscopic tattooing to mark the tumour site does not improve lymph node retrieval in colorectal cancer: a retrospective cohort study. J Negat Results Biomed 2015; 14:9. [PMID: 25947298 PMCID: PMC4430988 DOI: 10.1186/s12952-015-0027-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/23/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A direct correlation between number of lymph nodes retrieved and evaluated after a colectomy for colorectal cancer and survival of the patient has been reported, and consensus guidelines recommend to assess at least 12 lymph nodes for adequate staging. Many factors (i.e., patients' and tumour characteristics, surgeon, and pathologist) may influence the evaluation of the presence of neoplastic disease in lymph nodes as well as the total number of lymph nodes examined. Preoperative endoscopic tattooing to mark the site of the tumour has recently been suggested to facilitate the retrieval of lymph nodes in colorectal specimens. The aim of this study was to investigate its association with adequate lymphadenectomy (≥12 nodes) after colorectal resection for cancer. RESULTS All patients undergoing elective colorectal resection for cancer between 2009 and 2011 at the S. Anna University Hospital in Ferrara, Italy (N = 250) were retrospectively divided into two cohorts according to whether ink tattooing to mark the tumour site was performed during preoperative colonoscopy. The two cohorts were comparable regarding age, gender, body mass index, tumour location and size, TNM staging, and DNA microsatellite instability-high status. No difference between the tattoo (N = 107) and control (N = 143) groups could be detected in the rate of adequate lymphadenectomies performed (78% vs. 79%, p = 0.40). All factors known to influence lymph nodes retrieval from colorectal specimen were specifically evaluated. Rectal and colonic cancers were analysed together and separately. Full adjusted logistic regression analysis in patients who underwent colonic resection showed that right hemicolectomy (OR 4.72; CI95% 1.09-20.36) was the only factor associated to adequate lymphadenectomy. No association between ink tattooing performed preoperatively to mark the site of the tumour and adequate lymphadenectomy after colorectal resection was found with logistic regression analysis. CONCLUSION This study shows that preoperative ink tattooing utilized to mark the site of the tumour does not improve adequate lymphadenectomy and lymph nodes yield from colorectal cancer specimens. Further studies are therefore needed to determine if preoperative colonoscopic tattooing to mark the tumour site can refine staging.
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Affiliation(s)
- Carlo V Feo
- Department of Surgery, Unit of Clinica Chirurgica, S. Anna University Hospital of Ferrara, and University of Ferrara, Via Aldo Moro, 8 Room 2 34 03 (1C2), 44124, Ferrara, Cona, Italy.
| | - Mattia Portinari
- Department of Surgery, Unit of Clinica Chirurgica, S. Anna University Hospital of Ferrara, and University of Ferrara, Via Aldo Moro, 8 Room 2 34 03 (1C2), 44124, Ferrara, Cona, Italy.
| | - Michele Zuolo
- Department of Surgery, Unit of Clinica Chirurgica, S. Anna University Hospital of Ferrara, and University of Ferrara, Via Aldo Moro, 8 Room 2 34 03 (1C2), 44124, Ferrara, Cona, Italy.
| | - Simone Targa
- Department of Surgery, Unit of Clinica Chirurgica, S. Anna University Hospital of Ferrara, and University of Ferrara, Via Aldo Moro, 8 Room 2 34 03 (1C2), 44124, Ferrara, Cona, Italy.
| | - Vincenzo G Matarese
- Department of Medicine, Unit of Gastroenterology, S. Anna University Hospital of Ferrara, Ferrara, Italy.
| | - Roberta Gafà
- Department of Diagnostic Imaging and Laboratory Medicine, Unit of Anatomic Pathology, S. Anna University Hospital of Ferrara, and University of Ferrara, Ferrara, Italy.
| | - Elena Forini
- Unit of Statistics, S. Anna University Hospital of Ferrara, Ferrara, Italy.
| | - Giovanni Lanza
- Department of Diagnostic Imaging and Laboratory Medicine, Unit of Anatomic Pathology, S. Anna University Hospital of Ferrara, and University of Ferrara, Ferrara, Italy.
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Lörincz BB, Langwieder F, Möckelmann N, Sehner S, Knecht R. The impact of surgical technique on neck dissection nodal yield: making a difference. Eur Arch Otorhinolaryngol 2015; 273:1261-7. [PMID: 25784183 DOI: 10.1007/s00405-015-3601-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/02/2015] [Indexed: 11/26/2022]
Abstract
The nodal yield of neck dissections is an independent prognostic factor in several types of head and neck cancer. The authors aimed to determine whether the applied dissection technique has a significant impact on nodal yield. This is a single-institution, prospective study with internal control group (level of evidence: 2A). Data of 150 patients undergoing 223 neck dissections between February 2011 and March 2013 have been collected in a comprehensive cancer centre. Eighty-two patients underwent neck dissection with unwrapping the cervical fascia from lateral to medial, while 68 patients were operated without specifically unwrapping the fascia, in a caudal to cranial fashion. The standardised, horizontal neck dissection technique along the fascial planes resulted in a significantly higher nodal count in Levels I, II, III and IV, as well as in terms of overall nodal yield (mean: n = 22.53) than that of the vertical dissection applied in the control group (mean: n = 15.00). This is the first publication showing a direct correlation between neck dissection nodal yield and surgical technique. Therefore, it is paramount to optimise the applied surgical concept to maximise the oncological benefit.
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Affiliation(s)
- Balazs B Lörincz
- Head and Neck Cancer Centre of the Hubertus Wald University Cancer Centre Hamburg, Hamburg, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Felix Langwieder
- Head and Neck Cancer Centre of the Hubertus Wald University Cancer Centre Hamburg, Hamburg, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Nikolaus Möckelmann
- Head and Neck Cancer Centre of the Hubertus Wald University Cancer Centre Hamburg, Hamburg, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Susanne Sehner
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Rainald Knecht
- Head and Neck Cancer Centre of the Hubertus Wald University Cancer Centre Hamburg, Hamburg, Germany.
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Suda K, Kashchenko VA, Ishikawa K, Ishida Y, Uyama I. [OPTIMIZATION OF THE METHOD OF SUPRAPANCREATIC LYMPH NODE DISSECTION IN LAPAROSCOPY-ASSISTED GASTRECTOMY (IN THE FINAL ANALYSIS OF INTERNATIONAL CONFERENCES <<SCHOOL OF STOMACH SURGERY>>)]. Vestn Khir Im I I Grek 2015; 174:110-114. [PMID: 26234079 DOI: 10.24884/0042-4625-2015-174-2-110-114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
The article analyzed the methods of suprapancretic lymph node dissection in laparoscopic gastrectomy which were devel- oped and applied in Japan. The authors described the details of operation technique. There were noted the advantages of medial approach for suprapancreatic lymph node dissection.
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de Burlet KJ, van den Hout MFCM, Putter H, Smit VTHBM, Hartgrink HH. Total number of lymph nodes in oncologic resections, is there more to be found? J Gastrointest Surg 2015; 19:943-8. [PMID: 25691110 PMCID: PMC4412279 DOI: 10.1007/s11605-015-2764-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 01/26/2015] [Indexed: 01/31/2023]
Abstract
Pathologic staging of oncologic specimens includes the identification of the accurate lymph node status. Retrieving more lymph nodes leads to a more reliable N0 status in the TNM classification. The aim of this prospective study was to evaluate whether more lymph nodes can be retrieved from oncologic resection specimens when more time is invested in the search and if this contributes to a more reliable N-status in the individual patient. A total of 67 gastrointestinal oncologic specimens were reexamined for additional lymph nodes. The mean number of lymph nodes collected in the prospective group was compared against two retrospective groups, one before minima for lymph node counts were set (retrospective group 1) and one after (retrospective group 2). More lymph nodes were dissected per specimen in the prospective group (24.1 lymph nodes), compared to the retrospective group (14.3 lymph nodes, P = <0.001). During the study period, more patients were diagnosed as pN+ compared to the two retrospective groups (62.7 vs. 47.8 % respectively, P = 0.082). Significantly more lymph nodes can be found in oncologic specimens when more time is invested in the search. This will result in more accurate staging of the tumor.
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Affiliation(s)
- Kirsten J de Burlet
- Department of Surgery, K6-50, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands,
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Zhou G, Zhou Z. [The recognition to mesopancreas excision:surgical anatomy concept of standardization of regional lymph node dissection]. Zhonghua Wai Ke Za Zhi 2014; 52:807-808. [PMID: 25604018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Verlato G, Giacopuzzi S, Bencivenga M, Morgagni P, Manzoni GD. Problems faced by evidence-based medicine in evaluating lymphadenectomy for gastric cancer. World J Gastroenterol 2014; 20:12883-12891. [PMID: 25278685 PMCID: PMC4177470 DOI: 10.3748/wjg.v20.i36.12883] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 03/06/2014] [Accepted: 04/16/2014] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer surgical management differs between Eastern Asia and Western countries. Extended lymphadenectomy (D2) is the standard of care in Japan and South Korea since decades, while the majority of United States patients receive at most a limited lymphadenectomy (D1). United States and Northern Europe are considered the scientific leaders in medicine and evidence-based procedures are the cornerstone of their clinical practice. However, surgeons in Eastern Asia are more experienced, as there are more new cases of gastric cancer in Japan (107898 in 2012) than in the entire European Union (81592), or in South Korea (31269) than in the entire United States (21155). For quite a long time evidence-based medicine (EBM) did not solve the question whether D2 improves long-term prognosis with respect to D1. Indeed, eastern surgeons were reluctant to perform D1 even in the frame of a clinical trial, as their patients had a very good prognosis after D2. Evidence-based surgical indications provided by Western trials were questioned, as surgical procedures could not be properly standardized. In the present study we analyzed indications about the optimal extension of lymphadenectomy in gastric cancer according to current scientific literature (2008-2012) and surgical guidelines. We searched PubMed for papers using the key words “lymphadenectomy or D1 or D2” AND “gastric cancer” from 2008 to 2012. Moreover, we reviewed national guidelines for gastric cancer management. The support to D2 lymphadenectomy increased progressively from 2008 to 2012: since 2010 papers supporting D2 have achieved a higher overall impact factor than the other papers. Till 2011, D2 was the procedure of choice according to experts’ opinion, while three meta-analyses found no survival advantage after D2 with respect to D1. In 2012-2013, however, two meta-analyses reported that D2 improves prognosis with respect to D1. D2 lymphadenectomy was proposed as the standard of care for advanced gastric cancer by Japanese National Guidelines since 1981 and was adopted as the standard procedure by the Italian Research Group for Gastric Cancer since the Nineties. D2 is now indicated as the standard of surgical treatment with curative intent by the German, British and ESMO-ESSO-ESTRO guidelines. At variance American NCCN guidelines recommend a D1+ or a modified D2 lymph node dissection. In conclusion, D2 lymphadenectomy, originally developed by Eastern surgeons, is now becoming the procedure of choice also in the West. In gastric cancer surgery EBM is lagging behind national guidelines, rather than preceding and orienting them. To eliminate this lag, EBM should value to a larger extent Eastern Asian literature and should evaluate not only the quality of the study design but also the quality of surgical procedures.
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de Virgilio C, Frank PN, Grigorian A. Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery 2014; 156:591-600. [PMID: 25061003 PMCID: PMC7120678 DOI: 10.1016/j.surg.2014.06.016] [Citation(s) in RCA: 417] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 06/19/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The lymph node (Ln) status of patients with resectable pancreatic ductal adenocarcinoma is an important predictor of survival. The survival benefit of extended lymphadenectomy during pancreatectomy is, however, disputed, and there is no true definition of the optimal extent of the lymphadenectomy. The aim of this study was to formulate a definition for standard lymphadenectomy during pancreatectomy. METHODS During a consensus meeting of the International Study Group on Pancreatic Surgery, pancreatic surgeons formulated a consensus statement based on available literature and their experience. RESULTS The nomenclature of the Japanese Pancreas Society was accepted by all participants. Extended lymphadenectomy during pancreatoduodenectomy with resection of Ln's along the left side of the superior mesenteric artery (SMA) and around the celiac trunk, splenic artery, or left gastric artery showed no survival benefit compared with a standard lymphadenectomy. No level I evidence was available on prognostic impact of positive para-aortic Ln's. Consensus was reached on selectively removing suspected Ln's outside the resection area for frozen section. No consensus was reached on continuing or terminating resection in cases where these nodes were positive. CONCLUSION Extended lymphadenectomy cannot be recommended. Standard lymphadenectomy for pancreatoduodenectomy should strive to resect Ln stations no. 5, 6, 8a, 12b1, 12b2, 12c, 13a, 13b, 14a, 14b, 17a, and 17b. For cancers of the body and tail of the pancreas, removal of stations 10, 11, and 18 is standard. Furthermore, lymphadenectomy is important for adequate nodal staging. Both pancreatic resection in relatively fit patients or nonresectional palliative treatment were accepted as acceptable treatment in cases of positive Ln's outside the resection plane. This consensus statement could serve as a guide for surgeons and researchers in future directives and new clinical studies.
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Affiliation(s)
| | - Paul N. Frank
- General Surgery, Harbor-UCLA Medical Center, Torrance, California USA
| | - Areg Grigorian
- Department of Surgery, University of California, Irvine, Orange, California USA
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Chong C, Walters D, de Silva P, Taylor C, Spillane A, Kollias J, Pyke C, Campbell I, Maddern G. Subsequent axillary surgery after sentinel lymph node biopsy: results from the BreastSurgANZ Quality Audit 2006-2010. Breast 2013; 22:1215-9. [PMID: 24157405 DOI: 10.1016/j.breast.2013.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 08/19/2013] [Accepted: 09/22/2013] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To use data from the BreastSurgANZ Quality Audit (BQA) to examine the patterns of completion axillary lymph node dissection (cALND) after sentinel lymph node (SLN) biopsy in women treated for early breast cancer in Australia and New Zealand and to compare it to the Australian and New Zealand guidelines in cases of both positive and negative SLN results. MATERIALS AND METHODS Patients were sub grouped as having primary tumours ≤3 cm and >3 cm and further analysed according to year of surgery, SLN status and final nodal status where cALND was recorded. Multivariate analysis was performed examining tumour size, grade, presence of lymphovascular invasion (LVI), HER2 and oestrogen receptor status, patient age and number of positive sentinel nodes as predictors for subsequent axillary surgery. RESULTS 14879 patients were identified from 2006 to 2010. 79.8% of patients with a positive SLN result underwent cALND. Age >70 years and a greater number of involved SLN predicted no cALND among SLN positive patients. 10.3% of patients who had a negative SLN result underwent cALND. Younger age, higher grade, lymphovascular invasion and tumour size >3 cm predicted cALND among SLN negative patients. CONCLUSIONS According to the BQA from 2006 to 2010 the Australian and New Zealand guideline recommendations for SLN positive patients to have cALND and SLN negative patients not to have cALND were adhered to in 79.8% and 89.7% of cases respectively.
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Affiliation(s)
- Chilton Chong
- Department of Surgery, The Queen Elizabeth Hospital, South Australia, Australia.
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Oezcelik A. Optimal lymphadenectomy for esophageal adenocarcinoma. MINERVA CHIR 2013; 68:335-340. [PMID: 24019041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Recently published data have shown that an extended lymphadenectomy during the en bloc esophagectomy leads to a significant increased long-term survival for esophageal adenocarcinoma. On the other hand some studies indicate that the increased survival is based on stage migration and that the surgical complication rate is increased after extended lymphadenectomy. The aim of this review was to give an overview about all aspects of an extended lymphadenectomy in patients with esophageal adenocarcinoma. The review of the literature shows clearly that the number of involved lymph nodes is an independent prognostic factor in patients with esophageal adenocarcinoma. Furthermore, an extended lymphadenectomy leads to an increased long-term survival. Some studies describe that 23 lymph nodes should be removed to predict survival; other studies 18 lymph nodes or 15 lymph nodes. Opponents indicate that the survival benefit is based on stage migration. The studies with a large study population have performed a Cox regression analyzes and identified the number of lymph nodes removed as an independent factor for improved survival, which means it is significant independently from other parameters. Under these circumstances is stage migration not an option to explain the survival benefit. An important difficulty is, that there is no standardized definition of an extended lymphadenectomy, which means the localization and number of removed lymph nodes differ depending from the performing centre. The controversies regarding the survival benefit of the lymphadenectomy is based on the lack of standardisation of the lymphadenectomy. The main goal of further studies should be to generate a clear definition of an extended lymphadenectomy in patients with esophageal adenocarcinoma.
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Affiliation(s)
- A Oezcelik
- Department of General, Visceral and Transplantation Surgery, University of Essen, Essen, Germany -
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Meng MV, Nelson H. What is the appropriate extent of lymphadenectomy for bladder cancer? Bull Am Coll Surg 2013; 98:60-62. [PMID: 24010224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Dralle H, Musholt TJ, Schabram J, Steinmüller T, Frilling A, Simon D, Goretzki PE, Niederle B, Scheuba C, Clerici T, Hermann M, Kußmann J, Lorenz K, Nies C, Schabram P, Trupka A, Zielke A, Karges W, Luster M, Schmid KW, Vordermark D, Schmoll HJ, Mühlenberg R, Schober O, Rimmele H, Machens A. German Association of Endocrine Surgeons practice guideline for the surgical management of malignant thyroid tumors. Langenbecks Arch Surg 2013; 398:347-75. [PMID: 23456424 DOI: 10.1007/s00423-013-1057-6] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 01/30/2013] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Over the past years, the incidence of thyroid cancer has surged not only in Germany but also in other countries of the Western hemisphere. This surge was first and foremost due to an increase of prognostically favorable ("low risk") papillary thyroid microcarcinomas, for which limited surgical procedures are often sufficient without loss of oncological benefit. These developments called for an update of the previous practice guideline to detail the surgical treatment options that are available for the various disease entities and tumor stages. METHODS The present German Association of Endocrine Surgeons practice guideline was developed on the basis of clinical evidence considering current national and international treatment recommendations through a formal expert consensus process in collaboration with the German Societies of General and Visceral Surgery, Endocrinology, Nuclear Medicine, Pathology, Radiooncology, Oncological Hematology, and a German thyroid cancer patient support organization. RESULTS The practice guideline for the surgical management of malignant thyroid tumors includes recommendations regarding preoperative workup; classification of locoregional nodes and terminology of surgical procedures; frequency, clinical, and histopathological features of occult and clinically apparent papillary, follicular, poorly differentiated, undifferentiated, and sporadic and hereditary medullary thyroid cancers, thyroid lymphoma and thyroid metastases from primaries outside the thyroid gland; extent of thyroidectomy; extent of lymph node dissection; aerodigestive tract resection; postoperative follow-up and surgery for recurrence and distant metastases. CONCLUSION These evidence-based recommendations for surgical therapy reflect various "treatment corridors" that are best discussed within multidisciplinary teams and the patient considering tumor type, stage, progression, and inherent surgical risk.
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Affiliation(s)
- Henning Dralle
- Department of General, Visceral and Vascular Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06097, Halle, Saale, Germany.
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Hansen J, Rink M, Bianchi M, Kluth LA, Tian Z, Ahyai SA, Shariat SF, Briganti A, Steuber T, Fisch M, Graefen M, Karakiewicz PI, Chun FKH. External validation of the updated Briganti nomogram to predict lymph node invasion in prostate cancer patients undergoing extended lymph node dissection. Prostate 2013; 73:211-8. [PMID: 22821742 DOI: 10.1002/pros.22559] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 06/13/2012] [Indexed: 01/19/2023]
Abstract
PURPOSE We aimed to test accuracy and generalizability of a recently updated nomogram to assess the probability of lymph node invasion (LNI), when applied to a different European cohort of men undergoing radical prostatectomy (RP) with extended pelvic lymph node dissection (ePLND). MATERIALS AND METHODS The study cohort consisted of 1,282 men with clinically localized PCa who underwent RP and ePLND, including removal of obturator, external iliac, and hypogastric lymph nodes, between 01/2007 and 08/2011. Descriptive measurements included preoperative clinical and biopsy variables, such as prostate-specific antigen (PSA), clinical stage (CS), primary and secondary biopsy Gleason pattern, and percentage of positive cores. We used the area under curve (AUC) of the receiver operator characteristic analysis to quantify accuracy of the model to predict LNI. The extent of over- or under-estimation was explored graphically within loess calibration plots. RESULTS The median number of removed lymph nodes was 15 with an interquartile range of 12-20. Twelve percent (n = 155) of men had LNI. Preoperative clinical and biopsy characteristics differed significantly (all P ≤ 0.002) between men with LNI and those without. External validation of the previously reported updated LNI nomogram showed very good accuracy (AUC: 0.829). A nomogram-derived cut-off of 4% could lead to a reduction of 48% of lymph node dissection, while missing 10% of patients with LNI. CONCLUSIONS We report the external validation of an updated LNI nomogram, demonstrating accuracy and applicability in a different European cohort. A nomogram-derived cut-off of 4% confirmed good performance characteristics within a different external validation cohort.
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Affiliation(s)
- Jens Hansen
- Martini Clinic, Prostate Cancer Centre at University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
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Sengupta S, Webb DR. Editorial comment from Dr Sengupta and Dr Webb to pelvic lymph node dissection for prostate cancer: adherence and accuracy of the recent guidelines. Int J Urol 2012; 20:412. [PMID: 23075160 DOI: 10.1111/j.1442-2042.2012.03208.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Laudone VP, Silberstein JL. Editorial comment from Dr Laudone and Dr Silberstein to pelvic lymph node dissection for prostate cancer: adherence and accuracy of the recent guidelines. Int J Urol 2012; 20:411. [PMID: 23039361 DOI: 10.1111/j.1442-2042.2012.03190.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lewis A, Akopian G, Carillo S, Kaufman HS. Lymph node harvest in emergent versus elective colon resections. Am Surg 2012; 78:1049-1053. [PMID: 23025938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Quality measures for prognostication of colon cancer include the removal of 12 or more lymph nodes during colon resection. The purpose of this study was to determine whether emergent surgery is associated with inadequate lymph node harvest. The National Cancer Database (NCDB) was queried for colon cancer patients operated on at Huntington Memorial Hospital, Pasadena, California, from 2005 to 2010. Demographic data, indication for surgery, surgeon, stage, lymph node harvest, tumor location, method of surgery, chemotherapy use, and survival were recorded. Univariate analyses were performed to compare lymph node harvest with the variables listed. Three hundred fifty-three patients underwent colon resection between 2005 and 2010. Two hundred ninety-six patients with Stage I to III disease underwent 253 elective (85%) and 43 emergent (15%) colectomies. There was no statistical difference between rates of adequate lymph node harvest in emergent and elective patient groups (86.0 vs 88.1%, P=0.7). Inferior long-term survival was associated with emergent indication and inferior lymph node harvest. Lymph node harvest adequacy showed a gradual increase over time from 79.5 per cent in 2005 to 95.5 per cent in 2010. Despite a perception that emergent surgery is associated with inadequate lymphadenectomy, 5-year data from Huntington Memorial Hospital participation in NCDB does not suggest inferior lymph node harvests in patients operated on for obstruction or perforation.
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Affiliation(s)
- Aaron Lewis
- Huntington Hospital, Pasadena, California 91105, USA
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Mertens LS, Meijer RP, van Werkhoven E, Bex A, van der Poel HG, van Rhijn BW, Meinhardt W, Horenblas S. Differences in histopathological evaluation of standard lymph node dissections result in differences in nodal count but not in survival. World J Urol 2012; 31:1297-302. [PMID: 22875170 DOI: 10.1007/s00345-012-0916-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 07/16/2012] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To analyse whether the reported differences in nodal yield at pelvic lymph node dissection (PLND) for bladder cancer, between two hospitals, are reflected in the survival rates. PATIENTS AND METHODS We assessed follow-up data of all 174 patients (mean age: 62.7, median follow-up: 3 years) who underwent PLND between 1 January 2007 and 31 December 2009 at two different hospitals. PLND was performed according to a standardized template by the same urologists for comparable bladder cancer patients. Mean number of reported lymph nodes was 16 at hospital A versus 28 at hospital B. We compared the overall survival (OS), disease-specific survival (DSS) and recurrence-free survival (RFS) between both cohorts and performed a multivariate analysis. RESULTS The cumulative probability for 2-year OS, DSS and RFS for hospital A are 61, 64 and 54 %, versus 58, 58 and 53 % for hospital B, respectively. Kaplan-Meier survival curves did not reveal statistically significant differences between both groups (OS: p log-rank = 0.75, DSS: p log-rank = 0.56, and RFS: p log-rank = 0.80). Also after adjustment for pT stage and neoadjuvant chemotherapy, survival was not significantly different between hospital A and hospital B. CONCLUSION Despite differences in lymph node yield in PLND specimens, this study reveals no significant differences in survival outcomes between both hospitals. Standardized histopathological methods should be agreed upon by pathologists before integrating nodal yield and subsequent lymph node density as indicators of the quality of surgery and as prognostic factors.
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Affiliation(s)
- L S Mertens
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
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Abstract
In 2006 Meiron Thomas, writing in the British Journal of Surgery, made the following statement about the value of sentinel lymph node biopsy (SLNB) as a staging procedure in cutaneous malignant melanoma (1): "Perhaps a more important concern for those hoping to gain reassurance from accurate nodal staging relates to positive SN(S) that are prognostically inaccurate, information that can be devastating for the patient, leading to unnecessary lymphadenectomy and possibly unnecessary adjuvant therapy". In September 2011 Meyrick Ross and Gershenwald, writing in the Journal of Surgical Oncology, made the following statement about the management of patients with cutaneous malignant melanoma (2): "Sentinel node biopsy has become an important component of the initial management of many of these patients for accurate staging of regional lymph nodes, as well as enhanced regional disease control and improved survival in the patients with microscopically involved nodes." These two extremes have polarized the debate about the proper management of patients with malignant melanoma and have lead to widespread confusion and dismay amongst practicing clinicians, GP's and patient groups. In fact both statements are inaccurate, misleading and result from a false reading of the literature and in the case of Ross and Gershenwald a false interpretation of their own data (3). The following article explains why.
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Merkow RP, Bentrem DJ. Importance of and adherence to lymph node staging standards in gastrointestinal cancer. Surg Oncol Clin N Am 2012; 21:407-16, viii. [PMID: 22583990 DOI: 10.1016/j.soc.2012.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In gastrointestinal oncology, one of the most important factors influencing cancer-specific survival is the presence of positive lymph nodes. Although it remains controversial, adequate lymph node examination is required for accurate staging such that patients can receive appropriate adjuvant treatments and for stratification in clinical trials. Nevertheless, wide variation exists in the quality of lymph node examination in the United States, and many centers are not meeting guideline treatment recommendations.
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Affiliation(s)
- Ryan P Merkow
- Department of Surgery and Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Stiles BM, Nasar A, Mirza FA, Lee PC, Paul S, Port JL, Altorki NK. Worldwide Oesophageal Cancer Collaboration guidelines for lymphadenectomy predict survival following neoadjuvant therapy. Eur J Cardiothorac Surg 2012; 42:659-64. [PMID: 22491667 DOI: 10.1093/ejcts/ezs105] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES The Worldwide Oesophageal Cancer Collaboration (WECC) reported recommendations regarding the optimum number of lymph nodes to be removed during oesophagectomy based upon patients undergoing surgery alone. We sought to determine whether these recommendations are relevant in the case of oesophageal cancer (EC) patients receiving neoadjuvant therapy. METHODS Patients undergoing neoadjuvant chemotherapy followed by transthoracic en bloc oesophagectomy were reviewed. Patients were grouped by optimal versus suboptimal lymphadenectomy per WECC recommendations (pTis/T0/T1 ≥ 10; pT2 ≥ 20; pT3/T4 ≥ 30). Cohorts were compared for factors predicting optimal lymphadenectomy and for overall survival (OS). RESULTS During the time period, 135 patients (adeno = 100, squamous = 35) met the study criteria, of whom 94 patients (70%) had optimal lymphadenectomy. Optimal lymphadenectomy was more likely for tumours with lower ypT (P ≤ 0.001). Optimal lymphadenectomy predicted the OS (0.50, confidence intervals 0.29-0.85, P = 0.011), although it was collinear with ypT classification, which was also predictive. Patients not down-staged in ypT (n = 66, 49%) particularly experienced a trend towards improved 3-year survival with optimal lymphadenectomy (51 versus 29%, P = 0.144). Similarly, of patients with persistent nodal disease (n = 79, 59%), those who had optimal lymphadenectomy (n = 51) experienced improved 3-year OS compared with those with suboptimal lymphadenectomy (n = 28), (55 versus 36%, P = 0.087). CONCLUSIONS WECC recommendations regarding lymphadenectomy for EC may be applicable to patients undergoing oesophagectomy following neoadjuvant therapy, particularly those who are not down-staged by pathological tumour depth (T) classification and those with persistent nodal metastases. Techniques to enhance the extent of LAN should be pursued in this patient population.
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Affiliation(s)
- Brendon M Stiles
- Division of Thoracic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York 10021, USA.
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Dimofte G, Târcoveanu E, Taraşi M, Panait C, Lozneanu G, Nicolescu S, Porumb V, Grigoraş O. Mean number of lymph nodes in colonic cancer specimen: possible quality control index for surgical performance. Chirurgia (Bucur) 2011; 106:759-764. [PMID: 22308913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
UNLABELLED Lymphatic involvement in colonic cancer explains the need for extensive lymphadenectomy for intended curative operations. Surgical skills may determine the actual extent of the procedure and indirectly the number of lymphnodes (LN) removed from each specimen. MATERIAL AND METHODS We looked on a series of 329 consecutive patients with colonic cancer who underwent a standardized procedure including extensive lymphadenectomy. The main endpoints were survival as well as the number of LN and the mean number of RESULTS Differences in Kaplan-Meyer survival curves between average and high performance colectomies have been identifled for right colectomies both in stage II (85.7% vs 64.7%) as well in stage III (71.4% vs 56.5% 5-year survival), and also in stage II for segmental colectomies (85.7% vs 78.9%), showing a definitive advantage in survival for patients operated by surgeons with a mean LN retrieval above cutoff values. CONCLUSIONS our study suggests that the mean number of LN retrieved from the surgical specimen can be used to evaluate surgical performance in colonic cancer, and may reflect in postoperative survival. However care should be taken when extrapolating these data as surgeon-independent factors such as protocols for LN harvesting may be different in other institutions and will influence results.
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Affiliation(s)
- G Dimofte
- Department of Surgery, University of Medicine and Pharmacy "Gr. T. Popa" Iaşi, Biomedical Research Center, "St. Spiridon" University Hospital Iaşi, Romania.
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Abstract
Pelvic lymph node dissection is the only reliable technique to detect low-volume lymph node involvement in prostate cancer. Extended lymph node dissections that include the internal iliac chain in addition to the external iliac and obturator packets have shown a significantly higher proportion of patients to have lymphatic involvement than previously recognized. The improved staging afforded by a more extended dissection raises several questions. Addressing these questions is the focus of this review.
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Affiliation(s)
- Jeffrey C La Rochelle
- Division of Urology, Oregon Health & Science University, 3303 Southwest Bond Avenue, CH10U, Portland, OR 97239, USA
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