RESUMEN
AIM: Preoperative chemoradiation (CRT) for rectal cancer decreases the number of examined lymph nodes (NELN) found in the resected specimen. However, the prognostic role of lymph node evaluation including overall numbers and the lymph node ratio (LNR) in patients having preoperative CRT have not yet been defined. The study has assessed the influence of CRT on the NELN and on lymph node number and LNR on the survival of patients with rectal cancer. METHOD: Between 2003 and 2011, 508 patients with nonmetastatic rectal cancer underwent mesorectal excision. Of these 123 (24.2%) received preoperative CRT. Univariate and multivariate analysis was performed to define the role of NELN and LNR as prognostic indicators of survival. RESULTS: Neoadjuvant CRT significantly reduced the NELN (P < 0.0001). Disease-free survival (DFS) and overall survival (OS) of patients with fewer or more than 12 nodes retrieved did not differ statistically. Node-negative patients with six or fewer lymph nodes were significantly associated with a poor DFS and OS on univariate analysis (P = 0.03 and P = 0.03). LNR significantly influenced the DFS and OS on multivariate analysis [DFS, P = 0.0473, hazard ratio (HR) 2.4980, 95% confidence interval (CI) 1.2631-9.4097; OS, P = 0.0419, HR 1.1820, 95% CI 1.1812-10,710]. CONCLUSION: The cut-off of 12 lymph nodes does not influence survival and should not be considered for cancer-specific prediction of patients having neoadjuvant CRT. In contrast LNR is an independent prognostic predictor of DFS and OS in such patients.
Asunto(s)
Carcinoma/terapia , Quimioradioterapia Adyuvante/métodos , Escisión del Ganglio Linfático/métodos , Ganglios Linfáticos/patología , Neoplasias del Recto/terapia , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/mortalidad , Carcinoma/patología , Supervivencia sin Enfermedad , Femenino , Humanos , Ganglios Linfáticos/cirugía , Masculino , Persona de Mediana Edad , Análisis Multivariante , Pronóstico , Modelos de Riesgos Proporcionales , Neoplasias del Recto/mortalidad , Neoplasias del Recto/patología , Factores de TiempoRESUMEN
Cryptorchidism has an incidence of 0.8 - 2%, being undescendent testis nonpalpable in 20% of the cases. The latters have an increased risk of malignant transformation, infertility and epididymal malformation. Surgical treatment of nonpalpable testis is prone to failure compared to the palpable ones. Many diagnostic methods have been described; the most promising is the use of diagnostic laparoscopy which, compared to the imaging modalities, is more reliable to determine the site of the nonpalpable testis.