Articles de revues : « Para-Aortic lymph node dissection »

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Nomura, H., D. Aoki, N. Suzuki, N. Susumu, A. Suzuki, Y. Tamada, F. Kataoka, A. Higashiguchi, S. Ezawa et S. Nozawa. « Analysis of clinicopathologic factors predicting para-aortic lymph node metastasis in endometrial cancer ». International Journal of Gynecologic Cancer 16, n^o 2 (mars 2006) : 799–804. http://dx.doi.org/10.1136/ijgc-00009577-200603000-00053.

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The purposes of this study were to compare the relationships between para-aortic lymph node metastasis and various clinicopathologic factors to evaluate whether para-aortic lymph node dissection is necessary when treating endometrial cancer. A retrospective study was performed on 841 patients with endometrial cancer, who underwent the initial surgery at the Keio University Hospital. Clinicopathologic factors related to para-aortic lymph node metastasis significant on a univariate analysis were analyzed in a multivariate fashion using a logistic model. According to the multivariate analysis, the clinicopathologic factor most strongly related to the existence of para-aortic lymph node metastasis was positive pelvic lymph node metastasis (P< 0.01). Among the 155 patients who underwent pelvic and para-aortic lymph node dissection, the difference of 5-year overall survival by the presence of retroperitoneal lymph node metastasis was examined by Kaplan–Meier method. The prognosis was poor even if para-aortic lymph node dissection was performed in cases of positive para-aortic lymph node metastasis. In conclusion, when deciding whether to perform para-aortic lymph node dissection in patients with endometrial cancer, it is necessary to consider the pelvic lymph nodal status. If there is no pelvic lymph node metastasis, it could not be necessary to perform para-aortic lymph node dissection.

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Cho, Won Kyung, Yeon Joo Kim, Hakyoung Kim, Young Seok Kim et Won Park. « Significance of para-aortic lymph node evaluation in patients with FIGO IIIC1 cervical cancer ». Japanese Journal of Clinical Oncology 50, n^o 10 (24 juin 2020) : 1150–56. http://dx.doi.org/10.1093/jjco/hyaa091.

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Abstract Objective This study investigated the effect of para-aortic lymph node sampling or dissection in recently revised International Federation of Gynecology and Obstetrics IIIC1p cervical cancer treated with primary surgery and adjuvant radiation therapy with concurrent chemotherapy. Methods We retrospectively reviewed the records of 343 patients with early-stage cervical cancer and pathologically proven pelvic lymph node metastasis following curative surgery from 2001 to 2014. No patient had imaging evidence of para-aortic lymph node involvement, and all patients received adjuvant concurrent chemotherapy with or without concurrent chemotherapy. We investigated the significance of para-aortic lymph node sampling or dissection on disease-free survival and overall survival. Results After median follow-up of 58.3 months, 5-year disease-free survival and overall survival in all patients were 69.9 and 80.2%, respectively. Disease-free survival and overall survival did not differ between the para-aortic lymph node dissection group and the No para-aortic lymph node dissection group (P = 0.700 and P = 0.605). However, patients with para-aortic lymph node-positive disease had poorer disease-free survival and overall survival compared with those with para-aortic lymph node-negative disease (P < 0.001 and P < 0.001). Conclusions This study found no survival benefit of para-aortic lymph node evaluation among patients with International Federation of Gynecology and Obstetrics IIIC1p cervical cancer who were clinically para-aortic lymph node-negative. Although para-aortic lymph node metastasis is a poor prognosticator, the benefit of para-aortic lymph node dissection in terms of survival needs further investigation.

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Boran, Nurettin, Fulya Kayikçioğrlu, Gokhan Tulunay et M. Faruk Kose. « Scalene Lymph Node Dissection in Locally Advanced Cervical Carcinoma : Is it Reasonable or Unnecessary ? » Tumori Journal 89, n^o 2 (mars 2003) : 173–75. http://dx.doi.org/10.1177/030089160308900213.

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Aims and background The aim of this study was to evaluate the routine use of scalene lymph node dissection to determine the degree of disease spread in women with stage IIB-IVA cervical cancer treated at our hospital. Methods and study design Patients with locally advanced cervical carcinoma underwent para-aortic lymph node dissection via the extraperitoneal approach. Patients with clinical evidence of scalene or supraclavicular node metastasis were excluded. If their paraaortic nodes were tumor-positive, patients underwent scalene lymph node dissection. Results Twenty-eight scalene lymph node samplings were performed. Three patients had microscopically positive scalene lymph nodes (10.7%). In one patient the thoracic duct was injured. Conclusion Patients with cervical carcinoma whose only extrapelvic site of metastases is the para-aortic lymph nodes may be eligible for scalene lymph node dissection as part of their pretreatment assessment, especially if extended field radiation is considered.

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Noé, GK. « Retroperitoneal Para Aortic Lymph Node Dissection ». Journal of Minimally Invasive Gynecology 23, n^o 7 (novembre 2016) : S159. http://dx.doi.org/10.1016/j.jmig.2016.08.553.

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Sharma, V., A. Kumar, P. Khanna, G. Mediratta, N. Gupta, S. Naik et R. S. Sharma. « Laparoscopic Para-Aortic Lymph Node Dissection ». Journal of Minimally Invasive Gynecology 24, n^o 7 (novembre 2017) : S182. http://dx.doi.org/10.1016/j.jmig.2017.08.541.

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Bacalbasa, Nicolae, Irina Balescu, Mihaela Vilcu, Simona Dima, Camelia Diaconu, Laura Iliescu, Alexandru Filipescu, Mihai Dimitriu et Iulian Brezean. « The Risk of Para-Aortic Lymph Node Metastases in Apparent Early Stage Ovarian Cancer ». Medicina 56, n^o 3 (3 mars 2020) : 108. http://dx.doi.org/10.3390/medicina56030108.

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Background and objectives: To identify the risk factors for para-aortic lymph node metastases in cases with presumed early stage ovarian cancer. Materials and methods: Between 2014 and 2019, 48 patients with apparent early stage ovarian cancer were submitted to surgery. In all cases, pelvic and para-aortic lymph node dissection was performed for staging purposes. Results: Among the 48 cases we identified nine cases with positive pelvic lymph nodes and 11 cases with positive para-aortic lymph nodes. The positivity of the retrieved lymph nodes was significantly correlated with the histopathological subtype represented by serous histology (p = 0.02), as well as with the degree of differentiation (p = 0.004). Conclusions: Patients with serous ovarian carcinomas in association with a poorer degree of differentiation are at risk of associated lymph node metastases even in presumed early stages of the disease. Therefore, lymph node dissection should be performed in such cases in order to provide adequate staging and tailoring of further treatment.

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Santkovsky, I., et K. ElSahwi. « Robotic Infrarenal Para-Aortic Lymph Node Dissection ». Journal of Minimally Invasive Gynecology 21, n^o 6 (novembre 2014) : S224—S225. http://dx.doi.org/10.1016/j.jmig.2014.08.751.

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Vasilev, Steven A., et Kathryn F. McGonigle. « Extraperitoneal Laparoscopic Para-aortic Lymph Node Dissection ». Gynecologic Oncology 61, n^o 3 (juin 1996) : 315–20. http://dx.doi.org/10.1006/gyno.1996.0149.

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Wada, Takeyuki, Takaki Yoshikawa, Kenichi Ishizu, Tsutomu Hayashi et Yukinori Yamagata. « The optimal extent of lymph node dissection for gastric cancer with para-aortic lymph node metastases. » Journal of Clinical Oncology 41, n^o 4_suppl (1 février 2023) : 413. http://dx.doi.org/10.1200/jco.2023.41.4_suppl.413.

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413 Background: Gastric cancer (GC) with para-aortic lymph node (PAN) metastasis is diagnosed as stage IV and basically treated with chemotherapy. Recently, D2 and PAN dissection after neoadjuvant chemotherapy (NAC) was reportedly effective when PAN metastasis was limited within #16a2/b1 area. However, PAN dissection is highly invasive surgical procedure and it still remains unclear whether PAN dissection contributes to the survival for these tumors. This study aimed to determine the optimal extent of lymph node dissection for these tumors focusing on survival benefit of PAN dissection. Methods: The study examined patients who received radical gastrectomy with D2 and PAN dissection after NAC for gastric cancer with PAN metastasis (#16a2/b1) from 2004 to 2015. Survival benefit of lymph node dissection was estimated using therapeutic value index (TI). TI was calculated by multiplication of incidence of metastasis and 5-year survival rate of patients with metastasis for each lymph node area. TI of D2 dissection area (TI-D2) and PAN area (TI-PAN) was calculated separately. Overall survival (OS) was calculated in patients who had metastasis to PAN pathologically after surgery (pPAN+ group) and those who had not (pPAN- group). The recurrence site was also examined. Results: Thirty-two patients were analyzed. TI-D2 and TI-PAN were 15.6 and 0.0, respectively. 5y-OS was 81.0% in pPAN- group (21 cases) but was 0.0% in pPAN+ group (11 cases). The most frequent recurrence site was the lymph nodes (82.4% of all recurrences). Among lymph node recurrence, almost all recurrence patterns included the PANs (85.7% of lymph node recurrence). Conclusions: The prognosis was extremely poor when tumor cells remained on PAN after NAC. In these cases, PAN recurrence was seen most frequently even after PANs had been dissected. Patients with PAN could have the chance for the cure only when tumor cells on PAN was completely eliminated by NAC. It is unclear whether they actually needed PAN dissection for pathologically negative PAN. The optimal extent of lymph node dissection after NAC might be D2 for GC with PAN metastasis.

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Silva e Silva, A., C. Anton, D. Freitas, G. Favero et J. Paula Carvalho. « Chylous Fistula after Para-Aortic Lymph Node Dissection ». Journal of Minimally Invasive Gynecology 19, n^o 6 (novembre 2012) : S183. http://dx.doi.org/10.1016/j.jmig.2012.08.545.

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Muallem, Mustafa Zelal, Yasser Diab, Thomas Jöns, Jalid Sehouli et Jumana Muallem. « Nerve-Sparing Systematic Lymph Node Dissection in Gynaecological Oncology : An Innovative Neuro-Anatomical and Surgical Protocol for Enhanced Functional Outcomes ». Cancers 12, n^o 11 (22 novembre 2020) : 3473. http://dx.doi.org/10.3390/cancers12113473.

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Whilst systematic lymph node dissection has been less prevalent in gynaecological cancer cases in the last few years, there is still a good number of cases that mandate a systematic lymph node dissection for diagnostic and therapeutic purposes. In all of these cases, it is crucial to perform the procedure as a nerve-sparing technique with utmost exactitude, which can be achieved optimally only by isolating and sparing all components of the aortic plexus and superior hypogastric plexus. To meet this purpose, it is essential to provide a comprehensive characterization of the specific anatomy of the human female aortic plexus and its variations. The anatomic dissections of two fresh and 17 formalin-fixed female cadavers were utilized to study, understand, and decipher the hitherto ambiguously annotated anatomy of the autonomic nervous system in the retroperitoneal para-aortic region. This study describes the precise anatomy of aortic and superior hypogastric plexus and provides the surgical maneuvers to dissect, highlight, and spare them during systematic lymph node dissection for gynaecological malignancies. The study also confirms the utility and feasibility of this surgery in gynaecological oncology.

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Munkarah, A. R., A. Jhingran, R. B. Iyer, S. Wallace, P. J. Eifel, D. Gershenson et T. W. Burke. « Utility of lymphangiography in the prediction of lymph node metastases in patients with cervical cancer ». International Journal of Gynecologic Cancer 12, n^o 6 (2002) : 755–59. http://dx.doi.org/10.1136/ijgc-00009577-200211000-00012.

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Our objective was to assess the value of lymphangiography in selecting patients for surgical staging of locally advanced cervical cancer. We reviewed our computerized database to identify patients with cervical cancer who had abnormal findings on lymphangiography and underwent retroperitoneal lymph node dissection between September 1991 and January 1996. The records of these patients were retrospectively reviewed, and the following data were retrieved: clinical tumor stage and findings on lymphangiography at surgery, and on pathologic examination of resected lymph nodes. The lymphangiograms were reviewed and reinterpreted in blinded fashion by two of the authors. The positive and negative predictive values of lymphangiography for the presence of lymph node metastases were calculated, with findings on pathologic examination of lymph nodes used as the gold standard. The positive and negative predictive values of surgeons' clinical assessments at surgery were also calculated. Fifty patients met the selection criteria and constituted the study population. Fourteen patients (28%) had histologically negative nodes, and 36 patients (72%) had lymph node metastases. Thirty-three patients had metastases to pelvic nodes, 1515 patients had metastases to common iliac nodes, and 1616 patients had metastases to para-aortic nodes. The positive predictive value of lymphangiography for lymph node metastases was 74% for pelvic nodes, 73% for common iliac nodes, and 88% for para-aortic nodes. The negative predictive value of lymphangiography for lymph node metastasis was 76% for common iliac nodes and 77% for para-aortic nodes. Overall, 46% of the patients selected for surgical exploration had histologic findings of either common iliac or para-aortic lymph node metastases; these findings led clinicians to extend radiation fields to cover the para-aortic lymph nodes. Lymphangiography is helpful in selecting patients with cervical cancer who have a high risk of common iliac or para-aortic lymph node metastasis. However, more accurate and more readily available noninvasive methods of evaluating cervical patients for the presence of regional disease continue to be needed.

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Bao, Ruru, Mpano Olivier, Junmiao Xiang, Piaopiao Ye et Xiaojian Yan. « The Significance of Lymph Node Dissection in Patients with Early Epithelial Ovarian Cancer ». Annali Italiani di Chirurgia 95, n^o 4 (20 août 2024) : 628–35. http://dx.doi.org/10.62713/aic.3353.

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AIM: This study aimed to investigate the impact of lymph node dissection on the prognosis of early epithelial ovarian cancer and to assess the factors associated with lymph node metastasis. METHODS: In this retrospective study, we collected and analyzed the demographic characteristics, clinical pathological data, and perioperative adverse events in newly diagnosed early epithelial ovarian cancer (EOC) patients, Federation International of Gynecology and Obstetrics (FIGO) stage IA–IIA. The patients underwent surgical treatment at the First, Second, and Third Affiliated Hospitals of Wenzhou Medical University in Zhejiang Province, China, between June 2012 and June 2022. The survival analysis was performed. RESULTS: We enrolled 284 patients in this study, including 246 stage I, 28 stage II, and 10 stage III patients after surgery. Among them, 42 patients did not undergo lymph node dissection, 113 underwent pelvic lymph node dissection only, and 129 underwent pelvic plus para-aortic lymph node dissection. Among the lymph node dissection group, only 8 patients had lymph node metastasis (8/242, 3.3%), including 6 with pelvic lymph node metastasis and 2 with pelvic plus para-aortic lymph node metastasis. The median follow-up duration was 63 months. The systematic lymph node dissection group significantly prolonged the median operation duration and increased intraoperative blood loss and postoperative complications (p < 0.05). Postoperative multivariate Cox regression analysis revealed FIGO stage III as an independent risk factor for Progression-Free-Survival (PFS) and Overall Survival (OS) (p < 0.05). Furthermore, the preoperative cancer antigen 125 (CA125) level was observed as an independent factor affecting lymph node metastasis. CONCLUSIONS: Systematic lymph node dissection showed minimal effect on the survival rate of patients with clinically apparent early epithelial ovarian cancer and increased the postoperative complications of patients.

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Kim, Jae Heon, Tae Il Noh, Ji Sung Shim, Byeong Kuk Ham, Jae Hyun Bae et Jae Young Park. « Primary testicular carcinoid tumour with mature teratoma in undescended testis metastatic to lymph nodes ». Canadian Urological Association Journal 8, n^o 3-4 (14 avril 2014) : 245. http://dx.doi.org/10.5489/cuaj.383.

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We report a case of primary testicular carcinoid tumour with mature teratoma metastatic to the para-aortic lymph node and the lymph node around the left gonadal vein, which was treated with radical orchiectomy, bleomycin, etoposide, and cisplatin chemotherapy, and modified retroperitoneal lymph node dissection. Three days after modified retroperitoneal lymph node dissection, bleomycin-induced pneumonitis occurred, which was resolved with steroid administration. The patient is alive without recurrence 31 months after radical orchiectomy.

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Indolfi, P., G. Bisogno, G. Cecchetto, A. Ferrari, L. Piva, M. Carli, V. Donofrio, A. Schiavetti, G. De Salvo et A. Donfrancesco. « Is local lymph node involvement a prognostic factor in paediatric renal cell carcinoma ? » Journal of Clinical Oncology 25, n^o 18_suppl (20 juin 2007) : 20014. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.20014.

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20014 Background: RCC in childhood is rare. Children with RCC tend to have a similar overall prognosis when compared with adults, where prognosis worsens with increasing stage, although direct comparisons of adult and paediatric data isn’t easy. The aim of our study is to identify the prognostic significance of local lymph node involvement in children with Renal Cell Carcinoma (RCC). Methods: On the basis of a retrospective study, the recently founded Italian Association for Paediatric Hematology and Oncology-Rare Tumors Paediatric Age (AIEOP-TREP) identified 16 patients (9 females) with RCC and local lymph node involvement at 10 of these centers. The cases were observed among 59 paediatric RCC, corresponding to 27.1% of RCC presenting in Italy from January 1973 to May 2006. Results: Overall, 9 patients were alive and disease free at last follow-up: eight patients had regional lymph node dissection (RLND) from the diaphragm at the aortic bifurcation, and one had the para-aortic lymph nodes removal. Six patients died: one had RLND (died from progression of disease), three had the renal hilum lymph nodes removal, and two the para-aortic lymph nodes dissection. One patient was lost to follow-up after relapse: this patient had para-aortic lymph node removal at diagnosis. Estimated 25-year DFS and OS rates for all patients were 64.2% and 50.5%, respectively. Given the small number of patients, little can be said about the value, if any, of adjuvant immunotherapy in this group of RCC. Conclusions: Children with lymph node positive RCC had a relatively unfavourable long- term prognosis. In our experience the RLND improves the prognosis. Further investigation of the biologic differences is warranted. Because of the very low incidence of paediatric RCC, an international clinical trial will be required to establish optimal therapy for children with RCC. No significant financial relationships to disclose.

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Haas, C. A., et M. I. Resnick. « Laparoscopic Pelvic and Para-Aortic/ Retroperitoneal Lymph Node Dissection ». Surgical Innovation 3, n^o 2 (1 juin 1996) : 61–74. http://dx.doi.org/10.1177/155335069600300202.

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Ting, Wan-Hua, Shu-Wei Hsieh, Hui-Hua Chen, Ming-Chow Wei, Ho-Hsiung Lin et Sheng-Mou Hsiao. « Predictors for the Recurrence of Clinically Uterine-Confined Endometrial Cancer and the Role of Cytokeratin Immunohistochemistry Stain in the Era of Sentinel Lymph Node Mapping ». Cancers 14, n^o 8 (13 avril 2022) : 1973. http://dx.doi.org/10.3390/cancers14081973.

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Background: The primary objective of this study was to elucidate the predictors for cancer recurrence in women with clinically uterine-confined endometrial cancer in the era of sentinel lymph node (SLN) mapping. Methods: All consecutive women with clinically determined uterine-confined endometrial cancer who had lymph node assessment by either SLN mapping or traditional pelvic lymphadenectomy were reviewed. Results: Women in the SLN mapping group had lower total dissected pelvic nodes, lower incidence of para-aortic lymph node dissection, less intraoperative blood loss and lower complication rates, but a longer operation time compared to the traditional lymphadenectomy group. Para-aortic lymph node metastasis (hazard ratio = 7.60, p = 0.03) was the sole independent predictor for recurrence-free survival. In addition, the utilization of cytokeratin immunohistochemistry stain detected more lymph node metastases (adjusted odds ratio = 3.04, p = 0.03). Recurrence-free survival did not differ between SLN mapping and traditional lymphadenectomy groups (p = 0.24). Conclusions: Para-aortic lymph node metastasis is an important predictor of cancer recurrence. Women with negative hematoxylin and eosin stain should undergo cytokeratin immunohistochemistry stain to increase the detection rate of positive lymph node metastasis. Besides, the probabilities of recurrence seem to be similar between SLN mapping and traditional lymphadenectomy groups in women with clinically uterine-confined endometrial cancer.

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Cormio, G., A. Lissoni, A. Maneo, M. Marzola, A. Gabriele et C. Mangioni. « Lymph node involvement in primary carcinoma of the fallopian tube ». International Journal of Gynecologic Cancer 6, n^o 5 (septembre 1996) : 405–9. http://dx.doi.org/10.1136/ijgc-00009577-199609000-00010.

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Although the bad prognosis of primary fallopian tube carcinoma has been mostly ascribed to early lymphogenous dissemination, precise information regarding the characteristics of retroperitoneal spread are still missing. Our study was designed to evaluate the incidence and clinical significance of lymph node metastases in 33 patients with primary carcinoma of the fallopian tube. During primary surgery nine patients (27%) were submitted to systematic pelvic and para-aortic lymphadenectomy, whereas 24 received lymph node sampling. The clinicopathologic characteristics of the patients(intraperitoneal spread, grading, peritoneal cytology, depth of tubal infiltration and residual disease after primary surgery) were compared with lymphnodal status.Overall 15 patients (45%) had positive nodes, that is, invaded by tumor; whereas 18 (55%) showed no lymphatic spread. Six patients (40%) had exclusively positive para-aortic lymph nodes; five (33%) had only tumor metastases in pelvic lymph nodes, three (20%) manifested simultaneously pelvic and para-aortic spread, and one patient with pure primary squamous cell carcinoma had a massive groin node metastasis as presenting sign of the tumor. The rate of lymphogenous metastases was not significantly related to progressive intra-abdominal dissemination, histologic grade or depth of tubal infiltration. On the other hand, the presence of residual disease after primary surgery and positive peritoneal cytology significantly increased the risk of nodal metastases. Patients with lymph node metastasis had a significantly (P= 0.02) worse prognosis compared with patients without nodal involvement (median survival 39 vs 58 months).Considering the high incidence of lymph node metastasis, correct staging of tubal carcinoma should include a thorough surgical evaluation of both pelvic and para-aortic lymph nodes. The role of systematic lymph node dissection in the treatment of tubal carcinoma remains controversial.

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Kenichiro, Furukawa, Yosuke Matsumoto, Wataru Soneda, Yusuke Koseki, Keiichi Fujiya, Yutaka Tanizawa et Etsuro Bando. « Prophylactic para-aortic lymph node dissection after neoadjuvant chemotherapy for gastric cancer with bulky lymph node metastasis. » Journal of Clinical Oncology 42, n^o 3_suppl (20 janvier 2024) : 344. http://dx.doi.org/10.1200/jco.2024.42.3_suppl.344.

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344 Background: Neoadjuvant chemotherapy (NAC) followed by D2 gastrectomy with para-aortic lymph node dissection (PAND) is the standard treatment for gastric cancer with extensive lymph node metastasis (ELM) in Japan. ELM includes bulky lymph node metastasis along the celiac artery and its branches (Bulky N2) and metastasis of para-aortic lymph nodes (PAN). However, the benefit of PAND for gastric cancer with Bulky N2 but without PAN involvement is unclear. The aim of this study was to evaluate the efficacy of prophylactic PAND after NAC for this subgroup of patients. Methods: We retrospectively reviewed 21 patients who underwent NAC followed by curative (R0) gastrectomy for Bulky N2 (+) but PAN (-) gastric cancer from 2008 to 2019. Bulky lymph node was defined as one lymph nodes ≥ 3cm or two adjacent lymph nodes ≥ 1.5cm each. PAN metastasis included no. 16a2/16b1 lymph node metastasis. PAND was defined as systematic lymph node dissection of PAN. Patients were divided into two groups: a D2+PAND group (11 patients) and a D2 group (10 patients). We compared the clinicopathological features, recurrence patterns, and survival outcomes between the two groups. Results: The most common NAC regimen was S-1+cisplatin (12 patients: 57%), and other regimens in D2+PAND group included docetaxel+S-1+cisplatin or oxaliplatin. The D2+PAND group had longer operation time (p=0.006), and tended toward more undifferentiated histological type (p=0.063), better pathological response (p=0.086), and higher rate of adjuvant chemotherapy (p=0.090) than the D2 group. The ypStage was similar between the two groups. Pathological PAN metastasis was detected in two patients (18%) in D2+PAND group. Recurrence occurred in seven (70%) patients in D2 group and three (27%) patients in D2+PAND group, and lymph node recurrence was observed in four (40%), and one (10%) patients, respectively. The D2+PAND group had significantly better overall survival, recurrence-free survival, and disease-specific survival than the D2 group (p=0.008, 0.008, and 0.020, respectively). Conclusions: Prophylactic PAND after NAC may reduce recurrence risk for locally advanced gastric cancer with Bulky N2 but without PAN involvement.

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Handa, Y., H. Kato, H. Hareyama, K. Hada, M. Kaneuchi, M. Oikawa, T. Mitamura et al. « Retrospective analysis of two modes of lymphadenectomy (para-aortic + pelvic vs. pelvic alone) with regard to survival in endometrial cancer : A comparative study of two gynecologic units ». Journal of Clinical Oncology 25, n^o 18_suppl (20 juin 2007) : 5599. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.5599.

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5599 Background: Patients with endometrial cancer are at high risk of severe post-operative complications because of obesity, diabetes mellitus, and hypertension. The purpose of this study is, for minimizing surgical injury, to determine whether para-aortic lymph nodes dissection is dispensable. Methods: 295 patients received hysterectomy and lymphadenectomy during 1995 - 2005 in two gynecologic units of hospitals, one of where para-aortic lymph nodes (to the level of renal vein) and pelvic lymph node (PAN+PLN) dissection were routinely performed and the other only pelvic lymph node (PLN) were dissected, were enrolled. Their overall survival was retrospectively compared between these units. Results: Mean lymph node count was 58.9±19.7 in 99 patients with PAN+PLN lymphadenectomy, and 36.8±14.6 in 196 patients with PLN alone. 5-year survival was 93.3% in PAN+PLN cases and 92.9% in PLN, with no significant difference. Cases who died of the disease (DD) were 6.1% in PAN+PLN and 9.2% in PLN (relative risk = 0.660). Distribution in each stage was ignorable between two units; however, specific histology types, such as serous, clear cell, and carcinosarcoma, were highly counted in DD of the PLN unit. 5-year survival of only endometrioid type, excluding specific histology types, was 92.9% in PAN+PLN and 95.1% in PLN, and DD were 6.6% in PAN+PLN and 6.0% in PLN (RR = 1.095). Lymph node metastases were found 13.1% in PAN+PLN and 4.1% in PLN. One case was observed PAN-alone metastsis, where histology was serous type. Conclusions: Overall survival in patients received PAN+PLN and PLN dissection is not significantly different in endometrial cancer. It is supposed that only PLN dissection is sufficient and PAN dissection is omittable especially in endometrioid type, however, PAN+PLN lymphadenectomy might be suggestive to reduce death in specific histology types. No significant financial relationships to disclose.

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Song, Sung Ho, Soo Yeun Park, Jun Seok Park, Hye Jin Kim, Chun-Seok Yang et Gyu-Seog Choi. « Laparoscopic para-aortic lymph node dissection for patients with primary colorectal cancer and clinically suspected para-aortic lymph nodes ». Annals of Surgical Treatment and Research 90, n^o 1 (2016) : 29. http://dx.doi.org/10.4174/astr.2016.90.1.29.

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DOUSEI, Tsutomu, Kiyoshi YOSHIKAWA et Takashi EMOTO. « Partial Dissection of Para-aortic Lymph Node for Gastric Cancer ». Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons) 26, n^o 4 (2001) : 1121–25. http://dx.doi.org/10.4030/jjcs1979.26.4_1121.

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Ballester, M., E. Chéreau, G. Werkoff, S. Zilberman, E. Daraï et R. Rouzier. « Laparoscopic lumbo-aortic lymph node dissection ». Journal of Visceral Surgery 148, n^o 4 (septembre 2011) : e273-e278. http://dx.doi.org/10.1016/j.jviscsurg.2011.07.005.

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Lowe, M. P., et T. Tillmanns. « 423 : Robotic Aortic Lymph Node Dissection ». Journal of Minimally Invasive Gynecology 14, n^o 6 (novembre 2007) : S146. http://dx.doi.org/10.1016/j.jmig.2007.08.472.

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He, Misi, Lin Zhong, Haixia Wang, Ying Tang, Qi Zhou et Dongling Zou. « Randomized controlled trial of the efficacy of lymph node dissection on stage IIICr of cervical cancer (CQGOG0103). » Journal of Clinical Oncology 40, n^o 16_suppl (1 juin 2022) : TPS5604. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.tps5604.

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TPS5604 Background: In FIGO 2018, allowing assessment of retroperitoneal lymph nodes by imaging and/or pathological findings and, if deemed metastatic, the case is designated as stage IIIC (with r and p notations). Patients with lymph node metastases have lower overall survival (OS), progression free survival (PFS), and survival after recurrence, especially those who have unresectable macroscopically positive lymph nodes. Retrospective analysis suggests that there may be a benefit to debulking macroscopic nodes that would be otherwise difficult to sterilize with standard doses of radiation therapy. No prospective study reported that resecting macroscopic nodes before Concurrent chemoradiation therapy (CCRT) would improve PFS or OS of cervical cancer. The CQGOG0103 study is a national, prospective, multicenter and randomized clinical study evaluating lymph node dissection on stage IIICr of cervical cancer. Methods: Eligible patients are histologically confirmed cervical squamous cell carcinoma, adenocarcinoma, adeno-squamous cell carcinoma. Stage IIICr (confirmed by CT/MRI/PET/CT) and the short diameter of image-positive lymph node ≥15mm. 452 patients will be equally randomized to receive either CCRT (Pelvic EBRT/Extended-field EBRT + cisplatin (40mg/m2) or carboplatin (AUC = 2) every week for 5 cycles + brachytherapy) or Open/minimally invasive pelvic and para-aortic lymph node dissection followed by CCRT. Randomization is stratified by status of para-aortic lymph node. The primary endpoint is PFS. Secondary endpoints are OS and surgical complications. The sample size calculation of 346 patients provides 80% power to detect a difference in survival at the two-sided 5% significance level using the log-rank test, considering a 20% reduction, a total of 452 patients are required. This study began in January 2021 and will be accrued within 4 years. Enrollment is ongoing.

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He, Misi, Lin Zhong, Haixia Wang, Ying Tang, Qi Zhou et Dongling Zou. « Randomized controlled trial of the efficacy of lymph node dissection on stage IIICr of cervical cancer (CQGOG0103). » Journal of Clinical Oncology 40, n^o 16_suppl (1 juin 2022) : TPS5604. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.tps5604.

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TPS5604 Background: In FIGO 2018, allowing assessment of retroperitoneal lymph nodes by imaging and/or pathological findings and, if deemed metastatic, the case is designated as stage IIIC (with r and p notations). Patients with lymph node metastases have lower overall survival (OS), progression free survival (PFS), and survival after recurrence, especially those who have unresectable macroscopically positive lymph nodes. Retrospective analysis suggests that there may be a benefit to debulking macroscopic nodes that would be otherwise difficult to sterilize with standard doses of radiation therapy. No prospective study reported that resecting macroscopic nodes before Concurrent chemoradiation therapy (CCRT) would improve PFS or OS of cervical cancer. The CQGOG0103 study is a national, prospective, multicenter and randomized clinical study evaluating lymph node dissection on stage IIICr of cervical cancer. Methods: Eligible patients are histologically confirmed cervical squamous cell carcinoma, adenocarcinoma, adeno-squamous cell carcinoma. Stage IIICr (confirmed by CT/MRI/PET/CT) and the short diameter of image-positive lymph node ≥15mm. 452 patients will be equally randomized to receive either CCRT (Pelvic EBRT/Extended-field EBRT + cisplatin (40mg/m2) or carboplatin (AUC = 2) every week for 5 cycles + brachytherapy) or Open/minimally invasive pelvic and para-aortic lymph node dissection followed by CCRT. Randomization is stratified by status of para-aortic lymph node. The primary endpoint is PFS. Secondary endpoints are OS and surgical complications. The sample size calculation of 346 patients provides 80% power to detect a difference in survival at the two-sided 5% significance level using the log-rank test, considering a 20% reduction, a total of 452 patients are required. This study began in January 2021 and will be accrued within 4 years. Enrollment is ongoing.

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Yu, Juanpeng, Ting Yu, Shengsheng Yu et Yingchun Gao. « Short-term efficacy of laparoscopic type C radical hysterectomy by deep uterine vein approach for treatment of cervical cancer ». African Journal of Reproductive Health 28, n^o 12 (31 décembre 2024) : 73–81. https://doi.org/10.29063/ajrh2024/v28i12.8.

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This was an original research. The objective of the study was to investigate the efficacy of laparoscopic type C radical hysterectomy by deep uterine vein approach in treating cervical cancer. Two hundred cases of cervical cancer were allocated into control group and intervention group. The control group underwent pelvic lymph node dissection + para-aortic lymph node resection followed by extensive hysterectomy. The intervention group underwent laparoscopic type C radical hysterectomy by deep uterine vein approach + pelvic lymph node dissection ± para-aortic lymph node resection. In comparison with the control group, the intervention group had significantly lower amount of blood loss, longer time of indwelling catheter, shorter time of abdominal drainage tube removal and anal exhaust, lower incidence of postoperative complications, higher rate of pathological stage upgrading, and higher quality of life score, and had lower recurrence rate. We conclude that laparoscopic C-type radical hysterectomy by deep uterine vein approach is effective, safe and reliable, and can promote patients quality of life, which is valuable for clinical use.

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Yamada, Kazunosuke, Shunsuke Tsukamoto, Hiroki Ochiai, Dai Shida et Yukihide Kanemitsu. « Improving Selection for Resection of Synchronous Para-Aortic Lymph Node Metastases in Colorectal Cancer ». Digestive Surgery 36, n^o 5 (25 juillet 2018) : 369–75. http://dx.doi.org/10.1159/000491100.

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Introduction: The clinical benefit of extended lymphadenectomy for synchronous extraregional lymph node metastasis, such as para-aortic lymph node (PALN) metastasis in colorectal cancer, remains highly controversial. Aim: To evaluate the clinical benefit of PALN dissection in colorectal cancer patients with synchronous PALN metastasis with or without multiorgan metastases. Methods: Thirty-six patients with pathologically positive PALN metastasis below the renal veins who underwent concurrent PALN dissection and primary colorectal cancer resection from January 1984 through September 2011 at the National Cancer Center Hospital in Tokyo, Japan, were included in this retrospective cohort study. We examined 5-year recurrence-free survival (RFS) rates in patient groups depending on the number of nodes involved (≤2 and ≥3 nodes) and on the presence or absence of other organ involvement (M1a and M1b,c categories in TNM staging). Results: The 5-year RFS rate was significantly different depending on the number of metastatic PALNs (42.1 and 0.6% for PALN ≤2 and ≥3, respectively, p = 0.01). The 5-year RFS rate was significantly better in patients in the M1a category than in patients in the M1b and M1c categories (27.6 and 0.0%, respectively, p < 0.01). Twenty-nine patients (80.6%) experienced recurrence after PALN dissection. Postoperative complications were seen in 14 (38.9%) patients. Conclusion: PALN dissection below the renal veins for patients with isolated PALN metastasis with 2 or fewer involved PALNs may be effective in improving prognosis in colorectal cancer.

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Pervez, Ahmed, Naveen T. Mallikarjun, Asha Reddy et Cunnigaiper D. Narayanan. « Retrospective analysis of patients undergoing retroperitoneal lymph node dissection for carcinoma ovary comparing CT and histopathology : a single centre study ». International Surgery Journal 5, n^o 2 (25 janvier 2018) : 452. http://dx.doi.org/10.18203/2349-2902.isj20180039.

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Background: Ovarian cancer accounts for a large portion of female genital cancer and most are now detected in early stages. Importance is now placed on less radical surgeries and the exact role of RPLNDs is yet to be defined. The aim of the study is to analyse the clinicopathological status of patients who underwent retroperitoneal lymphnode dissection (RPLND) for carcinoma ovary and compare the size of the node on computerised tomography (CT) of abdomen with node positivity on histopathology (HPE). This is the first such study correlating CT findings of lymph node with pathological lympho-vascular invasion in RPLNDs done for carcinoma ovary from the Indian Subcontinent verified by literature search.Methods: A retrospective study of all patients who underwent RPLND diagnosed with ovarian cancer in our hospital over a period of 5 years (2011-15).Results: 41 patients with ovarian cancer who underwent RPLND were evaluated. Average age of study population was 49 years. Average tumor size was 9 cm. Analysis of para-aortic node size on CT abdomen with node positivity on HPE, a size criterion of 14mm or more was associated with node positivity. Analysis of correlation between size of the tumor and size of para-aortic node to para-aortic node positivity on HPE were both insignificant. There is correlation between size of the tumor to lymphovascular invasion on HPE.Conclusions: The primary tumor size and para-aortic lymph node size can predict lymphovascular invasion and a node size criterion of 14mm or more on CT can predict node positivity.

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Kondo, Hideyuki, Suguru Shirotake, Takashi Okabe, Soichi Makino, Koshiro Nishimoto et Masafumi Oyama. « Clinical Impact of Consolidative and Salvage Radiotherapy for Lymph Node Metastasis in Upper Urinary Tract Urothelial Carcinoma ». Case Reports in Urology 2018 (2018) : 1–6. http://dx.doi.org/10.1155/2018/1471839.

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A 75-year-old Japanese male was referred to our institution for the evaluation of a left ureteral tumor in the ureterovesical junction. Computed tomography and pathologic examination under ureteroscopy revealed an invasive left ureteral urothelial carcinoma with left obturator nodal metastasis without distant metastasis. First, the patient underwent systemic chemotherapy (gemcitabine and cisplatin chemotherapy). We then performed left radical nephroureterectomy and extended lymph node dissection. Pathological examination revealed that the tumor was a high-grade invasive urothelial carcinoma with left common iliac and pelvic lymph node metastasis (pT3N2). Unfortunately, metastases appeared in the common iliac and para-aortic lymph nodes immediately after the operation; therefore, the previous first-line chemotherapy was readministered and second-line chemotherapy (gemcitabine and paclitaxel chemotherapy) was also performed. We also performed consolidative radiotherapy and salvage radiotherapy (boost, 20 Gy/10 fractions to the inferior para-aortic, and left common iliac regions containing swollen lymph nodes). The patient has shown no evidence of recurrence or metastasis even approximately 4 years after the initial diagnosis of advanced UUT-UC with lymph node metastasis. Our case suggests that consolidative or salvage radiotherapy combined with surgery and chemotherapy may provide clinical benefit for selected cases of advanced UUT-UC with lymph node metastasis.

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Marano, Luigi, Ludovico Carbone, Gianmario Edoardo Poto, Valeria Restaino, Stefania Angela Piccioni, Luigi Verre, Franco Roviello et Daniele Marrelli. « Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era : Current Status, Clinical Implications and Contentious Issues ». Current Oncology 30, n^o 1 (8 janvier 2023) : 875–96. http://dx.doi.org/10.3390/curroncol30010067.

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Despite its decreasing incidence, gastric cancer remains an important global healthcare problem due to its overall high prevalence and high mortality rate. Since the MAGIC and FNLCC/FFCD trials, the neoadjuvant chemotherapy has been recommended throughout Europe in gastric cancer. Potential benefits of preoperative treatments include a higher rate of R0 resection achieved by downstaging the primary tumor, a likely effect on micrometastases and isolated tumor cells in the lymph nodes, and, as a result, improved cancer-related survival. Nevertheless, distortion of anatomical planes of dissection, interstitial fibrosis, and sclerotic tissue changes may increase surgical difficulty. The collection of at least twenty-five lymph nodes after neoadjuvant therapy would seem to ensure removal of undetectable node metastasis and reduce the likelihood of locoregional recurrence. It is not what you take but what you leave behind that defines survival. Therefore, para-aortic lymph node dissection is safe and effective after neoadjuvant chemotherapy, in both therapeutic and prophylactic settings. In this review, the efficacy of adequate lymph node dissection, also in a neoadjuvant setting, has been investigated in the key studies conducted to date on the topic.

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Tamura, Daisuke, Daichi Maeda, Yukihiro Terada et Akiteru Goto. « Distribution of Tattoo Pigment in Lymph Nodes Dissected for Gynecological Malignancy ». International Journal of Surgical Pathology 27, n^o 7 (2 mai 2019) : 773–77. http://dx.doi.org/10.1177/1066896919846395.

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Tattoo pigment migrates to regional lymph nodes, often causing acute or chronic lymphadenopathy. Past reports on tattoo lymphadenopathy are almost exclusively from Western countries. However, systemic distribution of tattoo pigment in lymph nodes has not been assessed in detail. In this article, we report a Japanese case of cervical adenocarcinoma, in which we successfully assessed the distribution of tattoo pigment deposition in pelvic and para-aortic lymph nodes. A 61-year-old woman with Japanese-style tattoos on both arms and her left thigh visited another clinic with postcoital bleeding. She was diagnosed with clinical stage 1B1 (cervical adenocarcinoma) and underwent radical hysterectomy and pelvic/para-aortic lymph node dissection. Histopathological examination revealed deposition of a black pigment in multiple lymph nodes. The pigment was more abundant in the left pelvic lymph nodes than in the para-aortic lymph nodes, a finding suggestive of pigment drainage from the tattoo on the left thigh. She remains free of disease more than 1 year after surgery. The diagnosis of tattoo lymphadenopathy is not easy when clinical information is lacking. The differential diagnoses include metastatic melanoma. Clinicians and pathologists should better recognize this phenomenon.

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Park, J. Y., M. C. Lim, S. Y. Lim, J. M. Bae, C. W. Yoo, S. S. Seo, S. Kang et S. Y. Park. « Port-site and liver metastases after laparoscopic pelvic and para-aortic lymph node dissection for surgical staging of locally advanced cervical cancer ». International Journal of Gynecologic Cancer 18, n^o 1 (janvier 2008) : 176–80. http://dx.doi.org/10.1136/ijgc-00009577-200801000-00030.

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Recently, we experienced a case of port-site and liver metastases after 75 cases of laparoscopic transperitoneal pelvic lymph node dissection (PLND) and para-aortic lymph node dissection (PALND) for surgical staging of locally advanced cervical cancer. A 45-year-old-woman with stage IIB cervical adenocarcinoma underwent laparoscopic PLND and PALND for surgical staging. There was no intraperitoneal disease and cervical tumor was not manipulated at the time of laparoscopic surgery. Pathologic examination revealed only one micrometastasis in left internal iliac lymph node (LN), measuring 1 mm, of the 60 pelvic and para-aortic LNs removed. She received concurrent chemoradiation therapy and pelvic mass disappeared completely. One month after the completion of therapy, both lateral and umbilical port-site and liver metastases were detected. We conclude that although cases of port-site metastasis have mostly occurred after extensive disease, the possibility of such complication should be kept in mind at laparoscopy of early cancer and laparoscopy which does not manipulate primary tumor.

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Lin, Alexander J., Jason D. Wright, Farrokh Dehdashti, Barry A. Siegel, Stephanie Markovina, Julie Schwarz, Premal H. Thaker, David G. Mutch, Matthew A. Powell et Perry W. Grigsby. « Impact of tumor histology on detection of pelvic and para-aortic nodal metastasis with 18F-fluorodeoxyglucose–positron emission tomography in stage IB cervical cancer ». International Journal of Gynecologic Cancer 29, n^o 9 (30 août 2019) : 1351–54. http://dx.doi.org/10.1136/ijgc-2019-000528.

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Objective18F-fluorodeoxyglucose–positron emission tomography (FDG-PET) detection of metastatic nodal disease is useful for guiding cervical cancer treatment but the impact of tumor histology is unknown. This study reports the detection of FDG avid pelvic and para-aortic lymph nodes in patients with early stage cervical cancer with squamous carcinoma and adenocarcinoma tumor histology.MethodsPatients with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB1-2 cervical cancer who underwent pre-surgical FDG-PET between March 1999 and February 2018 were identified in a tertiary academic center database. All patients had radical hysterectomy with pelvic and para-aortic lymph node dissection. Detection of pelvic and para-aortic lymph nodes by FDG-PET versus surgical dissection was compared. FDG-PET sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined and stratified by tumor histology.ResultsWe identified 212 patients with early stage cervical cancer (84% FIGO IB1, 16% IB2) who underwent pre-surgical FDG-PET; 137 (65%) patients had squamous carcinoma and 75 (35%) patients had adenocarcinoma. PET/computed tomography was performed in 189 (89%) patients and 23 (11%) had PET only. Surgical dissection revealed positive pelvic and para-aortic lymph nodes in 25% and 3.3% of patients, respectively. For squamous carcinoma, sensitivity, specificity, PPV, and NPV of FDG-PET for pelvic nodal metastasis were 44%, 99%, 95%, and 78%, respectively. For adenocarcinoma, the corresponding results for pelvic nodal metastasis were 25%, 99%, 67%, and 92%, respectively. The overall values for sensitivity, specificity, PPV, and NPV of FDG-PET for para-aortic nodal metastasis were 29%, 99%, 67%, and 98%, respectively.DiscussionPelvic nodal metastasis was less likely to be detected by FDG-PET in patients with early stage adenocarcinoma than with squamous carcinoma.

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SAKATOKU, Mitsuaki, Hirokatu KIKKAWA, Makoto HIRANO, Tomohiko MATSU, Eiki ISHIGURO, Hiroshi SAITO et Toshihiko TATSUZAWA. « Indication of para-abdominal aortic lymph node dissection in gastric cancer. » Japanese Journal of Gastroenterological Surgery 22, n^o 12 (1989) : 2789–92. http://dx.doi.org/10.5833/jjgs.22.2789.

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Yang, Kai, Xiang-Yi Zheng, Yan-Li Wang et Kui Zhao. « Alpha-fetoprotein and carbohydrate antigen 19-9 producing advanced adenocarcinoma of renal pelvis and ureter ». Canadian Urological Association Journal 7, n^o 11-12 (8 novembre 2013) : 750. http://dx.doi.org/10.5489/cuaj.1544.

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Tumour markers producing primary adenocarcinoma of upper urinary tract is extremely rare. We report a case of advanced adenocarcinoma of renal pelvis and ureter with highly elevated serum levels of alpha-fetoprotein (AFP) and carbohydrate antigen 19-9 (CA19-9). This 66-year-old man was diagnosed with left renal pelvic and ureteral tumours with para-aortic lymph node swelling, with no evidence of abnormality in his digestive or reproductive system. He was successfully treated with left nephroureterectomy and lymph node dissection followed by gemcitabine/carboplatin chemotherapy and the serum levels of AFP and CA19-9 decreased to normal. Pathological examination revealed a moderately or poorly differentiated intestinal-type adenocarcinoma with para-aortic lymph node metastasis. The patient was followed up for 11 months after surgery without recurrence.

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Bakır, Mehmet Sait, Ali Emre Tahaoğlu, Emre Erdoğdu et Cem Dane. « The Relationship of Myometrial Invasion Between Other Prognostic Parameters in Endometrial Cancer ». Gynecology Obstetrics & ; Reproductive Medicine 23, n^o 3 (5 décembre 2017) : 158. http://dx.doi.org/10.21613/gorm.2016.648.

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Objective: The aim of this study is to investigate the relationship between deep myometrial invasion and other prognostic factors in endometrial cancer. Recurrence rates, disease free survival and overall survival rates were evaluated in endometrial cancer patients with MI>50%.Sudy Design: A total of 132 patients with endometrial cancer who underwent surgical treatment between 2001 and 2011 were identified. Demographic, clinicopathological, surgical/adjuvant treatment and follow-up data were extracted. Results: Pelvic lymph node invasion ratio was 28,9% and para-aortic lymph node invasion ratio was 15,5% in patients with myometrial invasion is greater than 50%. Other prognostic factors especially lympho-vascular space invasion and pelvic/para-aortic lymph node metastasis were significantly higher when myometrial invasion is above 50% and also there was significant difference in recurrence rates, overall survival and disease free survival rates between patients with superficial and deep myometrial invasion (p<0.05).Conclusion: Myometrial invasion is an important prognostic parameter and can be determined intraoperatively to decide whether to perform pelvic and para-aortic lymph node dissection.

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TANGJITGAMOL, S., S. MANUSIRIVITHAYA, C. SHEANAKUL, S. LEELAHAKORN, M. SRIPRAMOTE, T. THAWARAMARA et N. KAEWPILA. « Can we rely on the size of the lymph node in determining nodal metastasis in ovarian carcinoma ? » International Journal of Gynecologic Cancer 13, n^o 3 (mai 2003) : 297–302. http://dx.doi.org/10.1136/ijgc-00009577-200305000-00006.

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This study endeavored to determine whether lymph node size is a reliable indicator in determining lymph node metastasis in common epithelial ovarian cancer. We reviewed pathologic sections of pelvic and para-aortic lymph nodes removed from 104 ovarian carcinoma patients who underwent either primary surgical staging or secondary surgery from January 1994 to July 2001. All sections of each individual node were measured in two dimensions. The different sizes of nodes were studied statistically to determine the optimal sensitivity and specificity in predicting cancer metastasis. A nodal size of 10 mm was a specific point of interest. Of 2069 total nodes obtained, 110 nodes (5.3%) had metastatic cancer. More than half (55.4%) of these positive nodes had a nodal long axis of 10 mm and less. The sensitivity and specificity of nodal size at 10 mm were 44.5% and 81.1%, respectively. We conclude that lymph node size is not a good indicator in determining epithelial ovarian cancer metastasis. Mere sampling of only the enlarged nodes does not reflect the true positive incidence of nodal metastasis. To avoid inaccurate staging and improper management, complete lymph node dissection is proposed as part of surgical staging for ovarian cancer.

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Tinelli, Raffaele, Miriam Dellino, Luigi Nappi, Felice Sorrentino, Maurizio Nicola D’Alterio, Stefano Angioni, Giorgio Bogani, Salvatore Pisconti et Erica Silvestris. « Eradication of Isolated Para-Aortic Nodal Recurrence in a Patient with an Advanced High Grade Serous Ovarian Carcinoma : Our Experience and Review of Literature ». Medicina 58, n^o 2 (6 février 2022) : 244. http://dx.doi.org/10.3390/medicina58020244.

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We report a case report regarding the eradication of isolated lymph-nodal para-aortic recurrence in the aortic region down the left renal vein (LRV) in a patient treated two years earlier in another hospital for a FIGO stage IC2 high-grade serous ovarian carcinoma with a video showing the para-aortic space after eradication of the metastatic tissue. A 66 year-old woman was admitted 24 months after the initial surgical procedure for an increased Ca 125 level and CT scan that revealed a 3 cm para-aortic infrarenal lymph-nodal recurrence that was confirmed by PET/CT scan. A secondary cytoreductive surgery (SCS) with a para-aortic lymph-nodal dissection of the tissue down the LRV and radical omentectomy were performed: during the cytoreduction, the right hemicolon was mobilized. The anterior surface of the inferior vena cava (IVC), aorta and LRV were exposed. The metastatic lymph nodes were detected in the para-ortic space down the proximal part of the LRV and eradicated; an en bloc infrarenal lymph-node dissection from the aortocaval region was performed. The operative time during the surgical procedure was 212 min with a blood loss of 120 mL. No intra- and postoperative complications, including ureteral or vascular injury or renal dysfunction, occurred. At histological examination, three dissected lymph nodes were positive for metastasis, and the patient was discharged five days after laparotomy without side effects and underwent chemotherapy 3 weeks later; after a follow-up of 42 months, no recurrence was detected. In conclusion, secondary debulking surgery can be considered a safe and effective therapeutic option for the management of recurrences, although long-term follow-ups are necessary to evaluate the overall oncologic outcomes of this procedure.

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Tokairin, Yutaka, Kagami Nagai, Hisashi Fujiwara, Taichi Ogo, Masafumi Okuda, Yasuaki Nakajima, Kenro Kawada et al. « Mediastinoscopic Subaortic and Tracheobronchial Lymph Node Dissection With a New Cervico-Hiatal Crossover Approach in Thiel-Embalmed Cadavers ». International Surgery 100, n^o 4 (1 avril 2015) : 580–88. http://dx.doi.org/10.9738/intsurg-d-14.00305.1.

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The use of mediastinal surgery for minimally invasive esophagectomy (MIE) has been proposed; however, this method is not performed as radical surgery because it has been thought to be impossible to perform complete upper mediastinal dissection, including the left tracheobronchial lymph nodes (106tbL). We herein describe a new method for performing complete dissection of the upper mediastinum. We developed a method for performing complete mediastinoscopic esophagectomy as radical surgery via the bilateral transcervical and transhiatal approach in 6 Thiel-embalmed human cadavers. The lower and middle mediastinal lymph nodes are dissected via the transhiatal approach. The dorsal side of the left recurrent nerve is dissected up to the aortic arch and left recurrent nerve lymph nodes (106recL) are dissected under pneumomediastinum. Next, the right recurrent nerve lymph nodes (106recR) are dissected. The cartilage of the left main bronchus is dissected and pushed downward, thereby obtaining a good view between the aortic arch and left main bronchus via the transhiatal approach. The 106tbL lymph nodes are dissected until the aortic arch is reached. Simultaneously, the lymph nodes are dissected via a right cervical incision. This method is termed the “cross-over technique.” We herein demonstrated that the upper mediastinal lymph nodes, including the 106tbL nodes, can be dissected using the bilateral transcervical and transhiatal approach under pneumomediastinum and named this method “mediastinoscopic esophagectomy with lymph node dissection” (MELD). MELD is therefore considered to be a useful modality based on our experience with Thiel-embalmed human cadavers.

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Zhou, Qian, et Xinliang Chen. « A deadly trap for para-aortic lymph node dissection in patients with horseshoe kidney as a complication : a case report ». Journal of International Medical Research 47, n^o 6 (20 mai 2019) : 2754–63. http://dx.doi.org/10.1177/0300060519845989.

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Horseshoe kidney is a rare congenital renal dysplasia. It is often associated with various anatomical abnormalities, including renal vessel and ureter variability, which increase unpredictable surgical risks. This current report describes the case of a 42-year-old woman diagnosed as having cervical squamous cell carcinoma complicated by horseshoe kidney. She underwent laparoscopic radical hysterectomy, bilateral oophorectomy and lymph node dissection, including dissection of the pelvic, presacral and para-aortic lymph nodes. The surgery was challenging, but no serious complications occurred. Postoperative multi-slice computed tomography angiography confirmed the anatomical variation of the renal location, ureter and renal vessels. To our knowledge, this is the first reported case of cervical carcinoma complicated with horseshoe kidney.

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Vagno, Giovanni Di. « What’s New in Gynaecological Oncology ? » European Oncology & ; Haematology 07, n^o 03 (2011) : 188. http://dx.doi.org/10.17925/eoh.2011.07.03.188.

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Is para-aortic lymph node dissection beneficial in the treatment of endometrial cancer? Para-aortic lymph node dissection is associated with a survival benefit in women with intermediate or high-risk endometrial cancer: a retrospective cohort study of women with endometrial cancer reported that eight-year, disease-specific survival rates were significantly higher for women with intermediate or high-risk disease who underwent combined pelvic and para-aortic lymph node dissection compared with pelvic lymph node dissection alone; there was, however, no significant difference in women with low-risk disease. What is the best, cutting-edge management for clear cell and papillary serous cancers of the endometrium? There is increasing evidence of the efficacy of an integrated and modified approach for these special histotypes compared with standard treatment for endometrial cancer: platinum/taxane-based chemotherapy is effective in determining relapse/survival benefits of both early- and advanced-stage patients. Is it possible to predict optimal cytoreduction in ovarian cancer? A high preoperative serum CA-125 level is associated with a lower likelihood of optimal cytoreduction: a meta-analysis of 14 studies found that serum CA-125 ≥500 U/ml has sensitivity and specificity for optimal cytoreduction of 69 and 63 %, respectively. Can multiple conisation procedures increase the risk of preterm delivery? The risk of preterm delivery increases in women with cervical intraepithelial neoplasia who undergo more than one cervical conisation. A population-based retrospective study reported that, compared with women who have undergone one prior conisation, the risk of preterm delivery increases threefold in women with two prior conisations. How often do the human papillomavirus (HPV) genotypes 16 and 18 cause invasive cervical cancer? In recent decades, the rate at which the major HPV genotypes (contained within HPV vaccines) caused invasive cervical cancers remained stable. This observation is crucial, given the large amount of public money invested in prophylactic HPV vaccine campaigns.

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Yafi, Faysal A., et Wassim Kassouf. « Role of lymphadenectomy for invasive bladder cancer ». Canadian Urological Association Journal 3, n^o 6-S4 (1 mai 2013) : 206. http://dx.doi.org/10.5489/cuaj.1197.

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Radical cystectomy with lymph node dissection remains the standardof care in the treatment of muscle-invasive and refractorynon-invasive bladder cancer. Over the past decade, the extent oflymphadenectomy has varied to include dissection up to the commoniliac vessels and aortic bifurcation proximally (may also extendup to the level of the inferior mesenteric artery), the genitofemoralnerve laterally, the circumflex iliac vein and lymph node of Cloquetdistally, and the hypogastric vessels posteriorly (obturator fossa,presciatic nodes bilaterally and the presacral lymph nodes overthe sacral promontory). Evidence supports the role of lymphadenectomyas both a therapeutic and prognostic variable in patientswith invasive bladder cancer. We review the literature regardingthe role and extent of lymphadenectomy, as well as its impact onpatient outcomes.

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Tokunaga, Masanori, Shigekazu Ohyama, Naoki Hiki, Tetsu Fukunaga, Susumu Aikou et Toshiharu Yamaguchi. « Can Superextended Lymph Node Dissection be Justified for Gastric Cancer with Pathologically Positive Para-aortic Lymph Nodes ? » Annals of Surgical Oncology 17, n^o 8 (25 février 2010) : 2031–36. http://dx.doi.org/10.1245/s10434-010-0969-4.

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Suh, Byoung Jo. « A Case of Advanced Gastric Cancer with Para-Aortic Lymph Node Metastasis Treated with Preoperative FOLFOX Chemotherapy Followed by Radical Subtotal Gastrectomy and D2 Lymph Node Dissection ». Case Reports in Oncology 10, n^o 1 (15 février 2017) : 182–91. http://dx.doi.org/10.1159/000457791.

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We report the case of a 73-year-old female who was diagnosed with advanced gastric cancer. Esophagogastroduodenoscopy was used to diagnose Borrmann type 3 advanced gastric cancer located at the gastric antrum. A biopsy revealed poorly differentiated adenocarcinoma. Abdominopelvic computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography-CT (FDG-PET-CT) scans demonstrated multiple lymph node metastases, including the para-aortic lymph nodes. Systemic chemotherapy with 5-fluoruracil (5-FU), oxaliplatin, and leucovorin (FOLFOX) was initiated. An abdominopelvic CT scan taken after 4 cycles of chemotherapy showed improvement in the ulceroinfiltrative gastric lesion and marked regression of several enlarged lymph nodes. Consequently, we performed a subtotal gastrectomy with D2 lymphadenectomy. The postoperative histopathological report was early gastric carcinoma with no lymph node metastasis in the 48 resected lymph nodes. Another 4 cycles of FOLFOX chemotherapy were performed after surgery. A FDG-PET-CT scan taken 12 months postoperatively showed no definite evidence of local recurrence or distant metastasis, and the previously noted retroperitoneal lymph nodes had disappeared. A FDG-PET-CT taken 16 months postoperatively showed multiple lymph node metastases, including the left supraclavicular lymph node. Despite 8 cycles of secondary chemotherapy with 5-FU, irinotecan, and leucovorin (FOLFIRI) and radiotherapy, the patient died 38 months after the operation.

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Aksarin, A. A., M. D. Ter-Ovanesov, A. A. Mordovsky, S. M. Kopeyka et P. P. Troyan. « LOBE-SPECIFIC METASTASIS IN NON-SMALL CELL LUNG CANCER ». Siberian journal of oncology 20, n^o 5 (31 octobre 2021) : 31–40. http://dx.doi.org/10.21294/1814-4861-2021-20-5-31-40.

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Aim: to identify the pathways of lymph node metastases in non-small cell lung cancer (NSCLC).Material and Methods. The frequency of mediastinal lymph node metastases and treatment outcomes were analyzed in 327 patients with stage I–III non-small cell lung carcinoma (NSCLC), who underwent lung resection with systematic lymph node dissection (SLND) between 2007 and 2011.Results. In cases with tumor location in any lobe of the right lung, metastasis occurred in the superior and inferior mediastinal lymph nodes. In left-side tumors, the main pathways of lymphatic spread of tumors were superior and inferior mediastinal nodes as well as aortic lymph nodes. Left lower lobe tumors metastasized most often to inferior mediastinal lymph nodes. Skip metastases were observed at any location of the tumor. Routine examination of all ipsilateral mediastinal lymph nodes overstaged NSCLC in 19.5 % of cases. The overall 5-and 10-year survival rates in patients with stage I–III NSCLC with SND were 61.5 % and 49.2 %, respectively. The median survival time was 103 months.Conclusion. Despite typical metastatic patterns of mediastinal lymph nodes in patients with NSCLC, non-specific metastasis was observed at any location of the tumor, which required mandatory systematic nodal dissection.

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Sun, Ke-kang, et Yong-you Wu. « Para-aortic lymph node dissection for colorectal cancer in the current era ». Asian Journal of Surgery 44, n^o 7 (juillet 2021) : 1019–20. http://dx.doi.org/10.1016/j.asjsur.2021.04.038.

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TAKEDA, JINRYO, KIKUO KOUFUJI, ISSEI KODAMA, YOSHIAKI TSUJI, MASAFUMI MARUIWA, SHINJI KAWABATA, TETSU SUEMATSU et TERUO KAKEGAWA. « Para-Aortic Lymph Node Dissection for the Treatment of Advanced Gastric Cancer. » Kurume Medical Journal 40, n^o 3 (1993) : 101–6. http://dx.doi.org/10.2739/kurumemedj.40.101.

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SUZUKI, Satoshi, Masatoshi KAWAMURA, Tsutomu KAETSU, Tomomi YAMAZAKI, Yuusuke TAJIMA, Hiroyuki NAGAYAMA, Kouichi TAKAMURA et al. « THE EFFECT OF PARA-AORTIC LYMPH NODE DISSECTION IN ADVANCED GASTRIC CANCER ». Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 60, n^o 8 (1999) : 2022–26. http://dx.doi.org/10.3919/jjsa.60.2022.

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Kobayashi, Hiroharu, Misa Kobayashi, Yoshihiro Takaki, Yuki Kondo, Yuri Hamada, Haruhiko Shimizu, Yumi Shimizu, Masaru Nagashima et Hiroshi Adachi. « Ureter Injury in Laparoscopic Para-Aortic Lymphadenectomy for Endometrial Cancer by the Transperitoneal Approach ». Case Reports in Obstetrics and Gynecology 2023 (19 septembre 2023) : 1–6. http://dx.doi.org/10.1155/2023/3138683.

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The patient was 66 years old, had three pregnancies and two deliveries, and was menopausal at the age of 51. She had irregular bleeding and was found to have a chicken-egg-sized uterus and a thickened endometrium (23 mm). She underwent laparoscopic surgery for uterine endometrial cancer (endometrioid carcinoma G1, stage IB). Laparoscopic simple hysterectomy, bilateral adnexectomy, pelvic lymph node dissection, para-aortic lymph node dissection, and partial omentectomy were performed using the transperitoneal approach (TPA). The patient was obese, with a height of 148 cm, a weight of 68 kg, and a body mass index of 31 kg/m2. She had a large amount of visceral fat, which made it difficult to expand the surgical field during para-aortic lymph node dissection. A laparoscopic fan retractor (EndoRetract II, Medtronic) was used to lift the intestinal tracts and expand the field of view. It broke the fat around the left kidney, and the exposed left ureter was heat-damaged using a vessel sealing device (LigaSure, Medtronic). Postoperatively, a left ureteral stent was placed, and continuous urine draining into the retroperitoneum was performed. To prevent injury to the left ureter, the left ovarian vein branching from the left renal vein should be exposed as a landmark before the left ureter running parallel to it is isolated. It is essential that the fat around the left kidney is not broken during this operation. The left iliopsoas muscle should be exposed, and using this as a base, the left ovarian vein, left ureter, and left perirenal fat should be compressed and moved to the left side using a fan retractor to ensure a safe operation.

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