Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.520
Filtrar
1.
Medicine (Baltimore) ; 99(33): e21085, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871979

RESUMO

The lymph nodal invasion diagnosis is critical for therapeutic-decision and follows up in gastric cancer. However, the number of nodes to be examined for nodal invasion diagnosis is still under controversy, and the model for quantifying risk of missing positive node is currently not reported yet. We analyzed the nodal invasion status of 13,857 gastric cancer samples with records of primary tumor stage, the number of examined and positive lymph nodes in the surveillance, epidemiology, and end results (SEER) database, fitting a beta-binomial model. The nodes need to be examined with different primary tumor stage were determined based on the model. Overall, examining 11 lymph nodes reduces the probability of missing positive nodes to <10%, and the currently median nodes dissected is adequate (12 nodes). While the number of nodes demands to be dissected for T1, T2, T3, and T4 subgroups are 6, 19, 40, and 66, respectively. The currently implemented median value for these samples was 12, 12, 13, and 16, separately. It implies that the number of nodes to be examined is sufficient for early gastric cancer (T1), but it is inadequate for middle and advanced gastric cancer (T2-T3). The clinical significance of nodal staging score was validated with survival information. In summary, we first quantified the lymph nodes to be examined during surgery using a beta-binomial model, and validated with survival information.


Assuntos
Linfonodos/patologia , Metástase Linfática/diagnóstico , Metástase Linfática/patologia , Estadiamento de Neoplasias/métodos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologia , Reações Falso-Negativas , Feminino , Humanos , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Probabilidade , Estudos Retrospectivos , Programa de SEER , Sensibilidade e Especificidade , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/cirurgia , Análise de Sobrevida
2.
N Z Med J ; 133(1520): 50-60, 2020 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-32994593

RESUMO

AIM: Therapeutic lymphadenectomy remains the gold standard for surgical management of clinically evident regional cervical disease for cutaneous malignancy. However, international consensus on adequate lymphadenectomy is lacking. Attempts have been made to establish quality measures; suggested benchmarks for minimum and average nodal yield, as well as recurrence and complication rates have been quoted. We aim to compare our key performance indicators to those benchmarks published in the literature. METHODS: This is a retrospective observational study conducted with prospectively maintained data, over an 11-year period (2007-2018). RESULTS: Of 91 cervical lymphadenectomies included, mean nodal yield for ≤3 and ≥4 dissection levels were 19.7 and 38.7 respectively. We observed a combined locoregional recurrence rate of 25%. Subgroup analysis for melanoma (60) and cSCC (28) revealing regional nodal recurrence of 15% and 11%, respectively. We observed a 38.5% complication rate; however, less than 5.5% was considered grade IIIb/IIIb(d) [Clavein-Dindo]. Median follow-up of 19.3 months, five-year survivial rate of 38% and 32% for melanoma and cSCC, respectively. CONCLUSION: Our data indicates that we are meeting quality measures, set by higher volume centres. We believe that any surgeon with subspecialty training in head and neck surgery can meet quality measures with regards to cervical lymphadenopathy for cutaneous malignancy.


Assuntos
Excisão de Linfonodo/métodos , Linfonodos/cirurgia , Pescoço/patologia , Neoplasias Cutâneas/patologia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Metástase Linfática/patologia , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Gradação de Tumores/métodos , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Nova Zelândia/epidemiologia , Guias de Prática Clínica como Assunto , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Neoplasias Cutâneas/secundário , Cirurgiões/educação , Taxa de Sobrevida
3.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(5): 451-455, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-32842423

RESUMO

Presacral recurrence, a special recurrence type in rectal cancer after surgical treatment, refers to recurrent cancer invading the presacral soft tissue or the bony structure of sacrum. It is also a major constituent of recurrent rectal cancer (15.63% to 41.67%). Reports show that presacral recurrence rate is about 2.8% to 4.8%, and it is associated with clinic staging, pathological type, surgical approach, (neo) adjuvant radiochemotherapy, tumor distance from the anus, positive circumferential margin, lymph node metastasis, and unilateral lateral lymph node dissection. CT and MRI are important for the detection of presacral recurrence. Presacral recurrence is always combined with local recurrence in other parts and distant organ metastasis. Therefore, we divide that into the following 3 types: 1) presacral recurrence with distant metastasis; 2) presacral recurrence with pelvic wall or lateral lymph node metastasis, or with recurrence of pelvic organs or anastomosis; and 3) simple presacral relapse. According to MDT evaluation. We adopt corresponding treatment scheme and surgical approach depending on the types mentioned above. When tumor recurred in the sacrum and located lower than S2/3 articular surface, then resection of recurrent tumor combined with sacrococcygeal should be the treatment of choice. For presacral recurrence with anterior invasion, combined total pelvic exenteration were available. For presacral recurrence with lateral pelvic wall invasion, internal iliac arteriovenous resection and lateral lymph node dissection and para-aortic lymph node dissection should be carried out. R0 resection may improve the 5-year overall survival rate of these patients.


Assuntos
Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Retais/epidemiologia , Neoplasias Retais/cirurgia , Sacro/cirurgia , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Sacro/patologia
4.
Urol Clin North Am ; 47(3): 371-377, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32600538

RESUMO

The role of lymph node dissection (LND) in the management of renal cell carcinoma (RCC) is controversial. LND serves an indisputable staging role by providing pathologic nodal stage. However, while earlier observational studies had suggested a survival benefit to LND, more recent observational evidence and a randomized trial do not support a survival benefit. The majority of patients with isolated lymph node involvement appear to harbor occult metastatic disease. Still, LND is not associated with increased perioperative morbidity when performed in experienced centers. LND may therefore play a predominantly staging role in patients at increased risk of lymph node metastases.


Assuntos
Carcinoma de Células Renais/patologia , Neoplasias Renais/patologia , Excisão de Linfonodo , Carcinoma de Células Renais/terapia , Humanos , Neoplasias Renais/terapia , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática , Estadiamento de Neoplasias
5.
Urol Clin North Am ; 47(3): 379-388, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32600539

RESUMO

Surgical metastasectomy continues to be utilized for patients with solitary or low-volume metastatic renal cell carcinoma (mRCC). Although few high-quality data are available to evaluate outcomes, local treatment is recommended when feasible because it may allow a subset of patients to delay or avoid systemic treatments. With the development of improved mRCC therapies, utilization of metastasectomy has increased because most patients have incomplete responses to systemic treatment of their metastases. This review discusses the rationale and history of metastasectomy, trends in utilization, prognostic factors for patient selection, site-specific considerations, alternatives for nonsurgical local treatment, and risk of morbidity associated with metastasectomy.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Metastasectomia/métodos , Carcinoma de Células Renais/secundário , Humanos , Neoplasias Renais/patologia , Excisão de Linfonodo , Linfonodos/patologia , Linfonodos/cirurgia , Estadiamento de Neoplasias , Nefrectomia
6.
Zhonghua Wai Ke Za Zhi ; 58(7): 505-511, 2020 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-32610419

RESUMO

Objective: To compare the short-term outcomes and long-term survivals of radical antegrade modular pancreatosplenectomy(RAMPS) and conventional distal pancreatectomy(CDP). Methods: A total of consecutive 304 patients including 176 male patients and 128 female patients who underwent RAMPS or CDP at Pancreas Center, the First Affiliated Hospital with Nanjing Medical University from May 2013 to June 2019 were retrospectively analyzed. The median age was 64.1 years old (range:39 to 85 years old). There were 101 patients underwent RAMPS and 203 patients underwent CDP. Measurement data with skewed distribution were presented as (M(Q(R))) and comparison between groups was evaluated with the Wilcoxon rank sum test. Count data were analyzed using the χ(2) test or Fisher exact probability. Survival analyses were performed by the Kaplan-Meier method after a one to one propensity score matching(PSM) conducted to balance several variables. Results: An eighty-one to eighty-one patients were enrolled after PSM. The overall morbidity was 32.1%(26/81)and there were no in-hospital mortalities in RAMPS. The median operative time was 225(95)minutes in RAMPS, not significantly longer as compared with CDP(210(130)minutes, P=0.916). The median greatest tumor diameter in RAMPS was 4.0(2.3)cm, not significantly larger as compared with CDP(4.5(2.2)cm, P=0.520).There were 34.6%(28/81)patients who presented with T4 tumors by 8(th) AJCC TNM staging system in RAMPS, which was not significantly different as compared with CDP(39.5%, χ(2)=0.574, P=0.902). The median number of examined lymph nodes was 9(9), not significantly greater in RAMPS as compared with CDP(10(11), P=0.992). The rate of negative posterior margins using 1 mm rule in RAMPS was 70.3%(52/74), significantly higher as compared with CDP(53.6%(30/56), χ(2)=3.817, P=0.044). The overall R0 resection rate was 44.6% (33/74) in RAMPS and 37.5% (21/56) in CDP, which was not significantly different(χ(2)=0.663, P=0.474). The median overall survival was 16.5 months for RAMPS, 25.2 months for CDP, and there was no statistical difference between two groups(P=0.981). The median overall survival was 16.0 months for patients with preoperative CA19-9≥300 U/ml who underwent RAMPS, 10.1 months for patients who underwent CDP, without significant difference(P=0.082). Conclusions: RAMPS can improve the rate of negative posterior margins by 1 mm rule and probably increase R0 resection rate and the harvest of lymph nodes. RAMPS may be beneficial to some patients with preoperative CA19-9≥300 U/ml.


Assuntos
Adenocarcinoma/cirurgia , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Esplenectomia/métodos , Adenocarcinoma/sangue , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígeno CA-19-9/sangue , Feminino , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Linfonodos/cirurgia , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/patologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
7.
Zhonghua Wai Ke Za Zhi ; 58(8): 596-599, 2020 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-32727189

RESUMO

Radical resection is one of the most important treatment for rectal cancer, which requires not only removal of adequate bowel and mesorectum around the tumor, but also thorough lymphadenectomy. Besides, postoperative complications are surgeons' concerns as well. According to different ways to manage inferior mesenteric artery, procedures could be divided into two groups: inferior mesenteric artery (IMA) high ligation and low ligation, which lead to various outcomes of the extent of lymph nodes dissection, survival, preservation of intestinal blood supply, incidence of anastomotic leakage, and postoperative functions including defecation function, urinary function and sexual function. Author believes that for those patients with clinical stage T1, low ligation and D2 lymph nodes dissection could be considered. However, for patients with locally advanced carcinomas (clinical stage T2+or N+), especially suspicious metastasis of lymph nodes around IMA root, high ligation and D3 lymph node dissection is suggested to ensure en bloc resection. As for those patients with high risks for compromised intestinal blood supply, preservation of left colic artery plus D3 lymph nodes dissection might be a feasible way. Intraoperative indocyanine green fluorescent imaging might play a role in quality control of lymphadenectomy.


Assuntos
Artéria Mesentérica Inferior/cirurgia , Protectomia/métodos , Neoplasias Retais/cirurgia , Colo/irrigação sanguínea , Colo/cirurgia , Humanos , Ligadura/métodos , Excisão de Linfonodo/métodos , Linfonodos/patologia , Linfonodos/cirurgia , Mesentério/irrigação sanguínea , Mesentério/cirurgia , Protectomia/efeitos adversos , Neoplasias Retais/irrigação sanguínea , Reto/irrigação sanguínea , Reto/cirurgia
8.
Zhonghua Wai Ke Za Zhi ; 58(8): 600-603, 2020 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-32727190

RESUMO

In order to increase the blood supply of anastomosis, surgeons choose to preserve the left colon artery (LCA) during the laparoscopic radical resection of rectal cancer. However, surgeons are always ailed by hemorrhage and incompletely dissection of No. 253 lymph nodes. One reason is the shortage of understanding the relationship between inferior mesenteric artery (IMA), LCA, and inferior mesenteric vein before surgery. Another reason is that surgeon always remove the lymph nodes around LCA, while don't normatively resect No. 253 lymph nodes, which affect the overall survival rate. Therefore, the "medial-to-lateral approach" for laparoscopic preservation with LCA radical resection in rectal cancer was suggested in this article. The CT technique could be used to analyze the IMA classification, which contribuated to the standard conservation of LCA. Laparoscopic radical resection of rectal cancer could be completed of high quality, through accurate definition and exactly dissection of the No. 235 lymph nodes.


Assuntos
Artéria Mesentérica Inferior/cirurgia , Neoplasias Retais/cirurgia , Reto/anatomia & histologia , Reto/cirurgia , Anastomose Cirúrgica/métodos , Humanos , Laparoscopia , Excisão de Linfonodo/métodos , Linfonodos/fisiologia , Linfonodos/cirurgia , Artéria Mesentérica Inferior/anatomia & histologia , Veias Mesentéricas/anatomia & histologia , Veias Mesentéricas/cirurgia , Reto/irrigação sanguínea
9.
Ann Surg ; 272(2): 357-365, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32675550

RESUMO

OBJECTIVE: Our aim was to evaluate recurrence patterns of surgically resected PDAC patients with negative (pN0) or positive (pN1) lymph nodes. SUMMARY BACKGROUND DATA: Pancreatic ductal adenocarcinoma (PDAC) is predicted to become the second leading cause of cancer death by 2030. This is mostly due to early local and distant metastasis, even after surgical resection. Knowledge about patterns of recurrence in different patient populations could offer new therapeutic avenues. METHODS: Clinicopathologic data were collected for 546 patients who underwent resection of their PDAC between 2005 and 2016 from 2 tertiary university centers. Patients were divided into an upfront resection group (n = 394) and a neoadjuvant group (n = 152). RESULTS: Tumor recurrence was significantly less common in pN0 patients as compared with pN1 patients, (upfront surgery: 55% vs. 77%, P < 0.001 and 64% vs. 78%, P = 0.040 in the neoadjuvant group). In addition, time to recurrence was significantly longer in pN0 versus pN1 patients in the upfront resected patients (median 16 mo pN0 vs. 10 mo pN1 P < 0.001), and the neoadjuvant group (pN0 21 mo vs. 11 mo pN1, P < 0.001). Of the patients who recurred, 62% presented with distant metastases (63% of pN0 and 62% of pN1, P = 0.553), 24% with local disease (27% of pN0 and 23% of pN1, P = 0.672) and 14% with synchronous local and distant disease (10% of pN0 and 15% of pN1, P = 0.292). Similarly, there was no difference in recurrence patterns between pN0 and pN1 in the neoadjuvant group, in which 68% recurred with distant metastases (76% of pN0 and 64% of pN1, P = 0.326) and 18% recurred with local disease (pN0: 22% and pN1: 15%, P = 0.435). CONCLUSION: Time to recurrence was significantly longer for pN0 patients. However, patterns of recurrence for pN0 vs. pN1 patients were identical. Lymph node status was predictive of time to recurrence, but not location of recurrence.


Assuntos
Carcinoma Ductal Pancreático/patologia , Causas de Morte , Linfonodos/patologia , Recidiva Local de Neoplasia/patologia , Neoplasias Pancreáticas/patologia , Idoso , Carcinoma Ductal Pancreático/mortalidade , Carcinoma Ductal Pancreático/cirurgia , Estudos de Coortes , Bases de Dados Factuais , Intervalo Livre de Doença , Feminino , Alemanha , Humanos , Linfonodos/cirurgia , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/cirurgia , Prognóstico , Pontuação de Propensão , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Resultado do Tratamento , Estados Unidos
11.
J Cancer Res Ther ; 16(2): 238-242, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32474507

RESUMO

Background and Objectives: The relative effectiveness of tracers in guiding para-aortic lymph node dissection (PAND) in advanced gastric cancer is undefined. In this single-center, prospective study, we aimed to discuss the effectiveness of such tracers. Materials and Methods: Between January 2015 and January 2016, 90 consecutive patients with stage T4a gastric cancer were evenly assigned to receive 0.2 mL of carbon nanoparticles (a), methylene blue (b), or no tracer (c) injection through no. 12b lymph nodes before PAND. Results: There was no difference in the baseline characteristics between the three groups. Group A vs. B or C had a higher number of dissected lymph nodes (34.1 ± 9.8, 25.5 ± 5.5, and 22.6 ± 3.7; P < 0.001; B vs. C: P =0.321) and no. 16a2/b1 para-aortic lymph nodes (PANs; 11.8 ± 4.8, 7.0 ± 1.2, and 5.5 ± 1.2; P < 0.001; B vs. C: P =0.178) and similar rates of lymph node metastasis (20.9 ± 17.5%, 19.1 ± 15.1%, and 23.6 ± 19.7%; P = 0.511), positive dissected PAN (23.3% [7/30], 16.7% [5/30], and 16.7% [5/30]), surgery duration (252.9 + 35.4, 244.4 ± 29.0, and 250.3 + 29.9 min; P = 0.421), and blood loss (266.7 ± 115.5, 270.0 ± 82.6, and 260.0 ± 116.3 mL, P = 0.933). There was no common bile duct damage by tracer injection, and one case of duodenal stump fistula, one abdominal infection, and two anastomotic leakages in Groups A-C, respectively, were treated successfully. Conclusions: In advanced gastric cancer treatment, carbon nanoparticle injection into no. 12b nodes appears to better trace no. 16a2/b1 PAN.


Assuntos
Carbono/química , Excisão de Linfonodo/métodos , Linfonodos/patologia , Linfonodos/cirurgia , Nanopartículas/administração & dosagem , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Corantes/administração & dosagem , Feminino , Humanos , Metástase Linfática , Masculino , Azul de Metileno/administração & dosagem , Pessoa de Meia-Idade , Estudos Prospectivos
13.
J Cancer Res Clin Oncol ; 146(10): 2709-2712, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32507972

RESUMO

PURPOSE: Squamous cell carcinoma of the vulva (SQCV) is the fifth common cancer in women. Necessity of inguinal lymph node surgery depends on the depth of stromal invasion, inducing lymph node surgery, if depth of invasion is more than 1 mm. In this study we tested the prediction of stromal infiltration depth by measurements in preoperative biopsies. METHODS: We analyzed whether a different operative strategy in respect to lymph node surgery would have been chosen based on the pre- or postoperative depth of stromal invasion for each patient. Examination of infiltration depth in preoperative biopsies and surgical specimen were compared. RESULTS: In total 77 patients were included in this study. Of those 89.6% showed different depths of stromal invasion comparing the pre- and postoperative specimen. Within seventeen patients (22.1%) preoperative depth was 1 mm or less and a postoperative depth was > 1 mm. CONCLUSION: We pointed, that only in 77.9% of the patients who should have undergo lymph node surgery based on the postoperative depth of infiltration underwent this procedure. Consequentially in 22.1% of the cases a second operation could not be prevented with a preoperative taken biopsy as indicator for the necessity of lymph node surgery.


Assuntos
Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Linfonodos/patologia , Linfonodos/cirurgia , Neoplasias Vulvares/patologia , Neoplasias Vulvares/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia/métodos , Feminino , Humanos , Excisão de Linfonodo , Metástase Linfática , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Centros de Atenção Terciária
14.
Oncol Res Treat ; 43(7-8): 380-387, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32564015

RESUMO

PURPOSE: Neck metastases in breast carcinoma are relatively rare and patients show poor survival rates. A controversy exists over whether neck metastases can be treated as distant or loco-regional metastases. The literature concerning the distribution of metastases in the neck is lacking, as well as data about whether metastases in the higher neck regions cause poorer survival than those in the supraclavicular fossa. METHODS: Ultrasound investigation with fine-needle biopsy was performed on 41 breast cancer and confirmed neck metastases patients in a 6-year period. We analysed the distribution of neck metastases and patient survival rates using Kaplan-Meier survival curves and Cox regression. RESULTS: The median survival time from the diagnosis of primary disease to that of neck metastases was 21 months. The presence of metastases in sites other than the neck significantly worsened survival, but multiple metastatic sites did not make it significantly worse. The number of nodes and presence of conglomerates did not considerably affect survival. CONCLUSION: Neck metastases in breast carcinoma can be found not only in the supraclavicular fossa, but elsewhere in the neck as well. Survival of patients with metastases in higher neck regions was shorter, but not very much so. Survival of patients with metastases limited just to the neck was substantially better, therefore early detection and aggressive treatment that could include neck dissection should be considered.


Assuntos
Neoplasias da Mama/mortalidade , Neoplasias de Cabeça e Pescoço/mortalidade , Linfonodos/patologia , Esvaziamento Cervical/métodos , Recidiva Local de Neoplasia/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Neoplasias da Mama/patologia , Feminino , Neoplasias de Cabeça e Pescoço/secundário , Humanos , Linfonodos/cirurgia , Metástase Linfática , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Prognóstico , Taxa de Sobrevida
15.
Zhonghua Wai Ke Za Zhi ; 58(5): 383-387, 2020 May 01.
Artigo em Chinês | MEDLINE | ID: mdl-32393006

RESUMO

Objective: To examine the clinical efficiency of laparoscopic gastroduodenostomy with BillrothⅠanastomosis with manual suture. Methods: The clinic data of 36 patients with gastric cancer who underwent laparoscopic gastroduodenostomy with Billroth Ⅰ anastomosis from November 2017 to September 2019 in Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital were analyzed retrospectively.There were 22 males and 14 females, aged (64.3±9.3) years(range: 43 to 80 years), underwent complete laparoscopic gastroduodenostomy. The laparoscopic manual suture was used for Billroth Ⅰ anastomosis. Results: All the laparoscopic radical gastrectomy and manual suturing gastroduodenostomy were successfully performed. The operation time was (226.7±40.4) minutes (range: 180 to 320 minutes), including (24.8±7.1) minutes (range: 15 to 48 minutes) for gastroduodenostomy.There was (3.8±0.9) days (range: 2 to 6 days) for anal exhaust, (5.7±2.0) days (range: 3 to 13 days) for extubation of gastric tube, and (10.3±3.1) days (range: 7 to 19 days) for hospitalization. There was no death in perioperative period. Postoperative pathological report showed 3 cases of highly differentiated adenocarcinoma, 5 cases of moderately differentiated adenocarcinoma, 22 cases of poorly differentiated adenocarcinoma and 6 cases of signet ring cell carcinoma, including 27 cases in T1 stage and 9 cases in T2 stage. The number of lymph nodes harvested was 36.4±8.9 (range: 23 to 60). Lymph node metastasis was positive in 7 cases and negative in 29 cases. TNM stage included 24 cases in ⅠA stage, 8 cases in ⅠB stage and 4 cases in Ⅱ stage. After the operation, the upper digestive tract radiography showed that the anastomosis opening was unobstructed without complications such as anastomotic stenosis. Conclusion: Laparoscopic gastroduodenostomy with Billroth Ⅰ anastomosis with manual suture is safe and feasible, has a good short-term effect.


Assuntos
Adenocarcinoma/cirurgia , Gastrectomia/métodos , Gastroenterostomia/métodos , Neoplasias Gástricas/cirurgia , Idoso , Anastomose Cirúrgica , Feminino , Humanos , Laparoscopia , Excisão de Linfonodo , Linfonodos/patologia , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Técnicas de Sutura
16.
Anticancer Res ; 40(5): 2889-2893, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32366439

RESUMO

BACKGROUND/AIM: Thrombosis internal jugular vein (IJV) with cervical adenopathy, as first manifestation of gastric cancer is rare. We aimed to compare resection of the cervical mass followed by gastrectomy with gastrectomy alone. PATIENTS AND METHODS: Nine patients presenting thrombosis of the IJV for gastric carcinoma were divided into two groups. Patients in group A (n=3) underwent anticoagulation treatment, gastrectomy and adjuvant treatment. Patients in group B (n=6) underwent resection of the cervical mass and internal jugular vein (radical neck dissection), and then gastrectomy and adjuvant treatment. RESULTS: Median survival was 15.3 months in group A (range=11-19 months) and 31.2 months in group B (range=7-44 months) (p=0.11). Late cervical recurrence/complications occurred in 2 patients in group A and none in group B (p=0.02). CONCLUSION: Resection of thrombosed IJV and satellite lymph nodes, due to a primary gastric cancer may contribute to diagnosis of the disease, limit pulmonary embolic complications and improve quality of life.


Assuntos
Veias Jugulares/patologia , Linfonodos/cirurgia , Neoplasias Gástricas/complicações , Trombose Venosa/cirurgia , Feminino , Humanos , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia
17.
J Surg Oncol ; 122(2): 336-343, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32410255

RESUMO

OBJECTIVES: The ligation of thoracic duct interrupts the normal lymphatic circulation. Whether the ligation of thoracic duct would affect tumor recurrence and patient survival is unclear. METHODS: The correlations between prophylactic thoracic duct ligation (PLG) and prognosis were examined in patients with esophageal squamous cell carcinoma. Patients who received Ivor Lewis or McKeown esophagectomy with systemic lymph node dissection and R0 resection between 2003 and 2013 in Sun Yat-sen University Cancer Center were included in the study. RESULTS: A total number of 473 and 462 were included in the PLG group and non-prophylactic thoracic duct ligation (NPLG) group, respectively. The PLG group had a lower 5-year survival rate (48.2% vs 61.6%, P < .001). After a 1:1 propensity score matching, 874 cases (437 pairs) were included and the survival analysis showed that PLG was associated with worse 5-year cumulative survival of 48.6% vs 61.6% in those patients without ligation (P < .001). The multivariate analysis revealed that PLG was an independent factor for poor prognosis after esophagectomy (hazard ratio, HR = 1.56; 95% confidence interval, 95% CI, 1.26-1.93, P < .001). Additionally, PLG was associated with regional lymph node relapse (P = .015). CONCLUSIONS: PLG should not be performed routinely if no sign of thoracic duct rupture or tumor invasion were identified.


Assuntos
Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago/cirurgia , Linfonodos/patologia , Linfonodos/cirurgia , Recidiva Local de Neoplasia/patologia , Ducto Torácico/cirurgia , Quilotórax/epidemiologia , Quilotórax/etiologia , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/mortalidade , Carcinoma de Células Escamosas do Esôfago/patologia , Esofagectomia/métodos , Esofagectomia/estatística & dados numéricos , Feminino , Humanos , Ligadura/métodos , Ligadura/estatística & dados numéricos , Excisão de Linfonodo/métodos , Excisão de Linfonodo/estatística & dados numéricos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/mortalidade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Prognóstico , Pontuação de Propensão , Estudos Retrospectivos , Taxa de Sobrevida
18.
Anticancer Res ; 40(4): 2351-2357, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234937

RESUMO

BACKGROUND/AIM: The prognosis of gastric cancer with para-aortic or bulky lymph node metastases is poor, but the JCOG 0405 study showed relatively good outcomes of neoadjuvant chemotherapy and gastrectomy with para-aortic lymph node dissection. We investigated the prognostic factors for this treatment. PATIENTS AND METHODS: Twenty patients who underwent gastrectomy and para-aortic lymph node dissection after chemotherapy were enrolled from two institutions. The prognostic factors for overall survival were retrospectively analysed using Cox's proportional hazard models. RESULTS: The univariate analyses revealed that ypN (3/0-2, p=0.001), ypM1 (para-aortic LYM) (yes/no, p=0.03), histological response (Grade0-1b/2-3, p=0.02), and adjuvant chemotherapy (no/yes, p=0.02) were significant prognostic factors, whereas multivariate analysis revealed ypN and absence of adjuvant chemotherapy to be independent prognostic factors. CONCLUSION: Posttreatment nodal status may be the best surrogate marker for gastric cancer with gastrectomy and para-aortic lymph node dissection after neoadjuvant chemotherapy. Adjuvant chemotherapy seems to be essential to improve survival.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Gastrectomia/métodos , Excisão de Linfonodo/métodos , Linfonodos/cirurgia , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/cirurgia , Idoso , Quimioterapia Adjuvante , Cisplatino/administração & dosagem , Terapia Combinada , Feminino , Humanos , Estimativa de Kaplan-Meier , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
19.
Ann R Coll Surg Engl ; 102(5): 355-362, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32326735

RESUMO

INTRODUCTION: Gastric cancer is the fourth most common cancer in the world. By the time the patients are diagnosed with stage IV gastric cancer, many patients already have distant metastases. There is no unified systemic treatment plan in existence. The use of gastrectomy is ambiguous in patients with stage IV gastric cancer. The objective of this study was to evaluate the beneficial outcome of gastrectomy in patients with stage IV gastric cancer. METHODS: Clinical information of patients with gastric cancer from 2000 to 2010 in the Surveillance, Epidemiology, and End Results database were extracted and analysed. The risk factors for stage IV gastric cancer were also analysed. RESULTS: We observed that the median survival time for patients after surgery was greater than that for patients not treated surgically. The five-year survival rate for chemotherapy patients was higher than that of non-chemotherapeutic patients. Patients who receive both chemotherapy and surgery could achieve a more significant survival benefit. The risks following gastrectomy (partial, subtotal, hemi-) were lower than those of other surgical procedures, which provided guidance on the choice of surgical method. The numbers of regional lymph node metastasis were found to be related to prognosis. CONCLUSIONS: In patients with stage IV gastric cancer, gastrectomy (partial, subtotal or hemi) should be selected when surgery is necessary. The number of regional lymph node metastasis could be considered as a prognostic factor for patients with stage IV gastric cancer and lymph node dissection could reduce the risk of patients undergoing surgery.


Assuntos
Gastrectomia/métodos , Excisão de Linfonodo/métodos , Metástase Linfática , Neoplasias Gástricas/epidemiologia , Idoso , Feminino , Gastrectomia/estatística & dados numéricos , Humanos , Excisão de Linfonodo/estatística & dados numéricos , Linfonodos/patologia , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Seleção de Pacientes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Programa de SEER/estatística & dados numéricos , Estômago/patologia , Estômago/cirurgia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Taxa de Sobrevida , Resultado do Tratamento , Estados Unidos/epidemiologia
20.
Medicine (Baltimore) ; 99(15): e19795, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282744

RESUMO

In the 7th edition of AJCC staging system, cervical lymph node metastases (LNM) in papillary thyroid carcinoma (PTC) is considered as a poorer prognostic indicator only in patients aged 45 years or older, but as a low-risk factor in patients younger than 45 years. The objective of this study is to investigate the influence of cervical LNM on prognostic outcomes of young patients (<45 years' old) with PTC.We carried out a retrospective analysis of 1896 PTC patients younger than 45 years' old at diagnosis, who were firstly treated in our department between January 2005 and December 2014. Clinicopathologic features, recurrences, disease-free survival (DFS) were recorded and analyzed.A total of 1896 consecutive patients were identified, comprising of 426 males and 1470 females after a median follow-up period of 40 months (3-129 months) from initial surgery to disease recurrence or to the end of follow-up. The rate of recurrence was 2.16% (n = 41). The DFS rates for a 1-year, 3-year, or 5-year team were 99.1%, 97.8%, or 97.4%, respectively. Univariate analysis showed that diagnosed age ≤30 years, tumor size >1.0 cm, extrathyroidal extension, multifocal lesions, lesions in bilateral lobes, central neck LNM, and lateral neck LNM were associated with a worse DFS. Multivariate analysis showed that only central neck LNM and lateral neck LNM were significant independent prognostic factors for DFS (P < .001). For patients with papillary thyroid microcarcinoma, cervical LNM were also identified as independent risk factors for DFS (P < .001).LNM have prognostic significance for DFS in PTC patients younger than 45 years. It indicated that PTC patients (<45 years old) with LNM, especially lateral neck LNM, were understaged by the 7th edition of AJCC staging system. Thus, radical resection of primary tumor and metastatic lymph nodes, frequent follow-up, and strict TSH suppression should be taken for young patients with PTC.


Assuntos
Linfonodos/patologia , Metástase Linfática/patologia , Receptores da Tireotropina/antagonistas & inibidores , Câncer Papilífero da Tireoide/patologia , Adulto , Carcinoma Papilar/mortalidade , Carcinoma Papilar/patologia , Intervalo Livre de Doença , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/cirurgia , Masculino , Margens de Excisão , Pescoço/patologia , Recidiva Local de Neoplasia/epidemiologia , Estadiamento de Neoplasias/métodos , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Câncer Papilífero da Tireoide/mortalidade , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/mortalidade , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA