ObjectiveTo investigate the predictive value of recurrent laryngeal nerve lymph nodes (RLN) status for supraclavicular lymph node (SLN) metastasis in esophageal squamous cell carcinoma.MethodsWe retrospectively analyzed the clinical data of 83 patients with esophageal squamous cell carcinoma who underwent McKeown three-field lymphadenectomy from January 2017 to April 2018 in our hospital, including 53 males and 30 females with an average age of 64.07±7.05 years.ResultsThe SLN metastasis rate of the patients was 24.1%. The rate in the thoracic and abdominal metastases positive (N1-3) group and negative (N0) group was 37.8% and 13.0%, respectively, with a statistical difference (P<0.05). The rate of SLN metastasis was significantly different between the RLN metastasis positive (RLN+) and negative (RLN–) groups (39.1% vs. 18.3%, P<0.05). One side of RLN metastasis could lead to SLN metastasis on the opposite side. No correlation between the SLN metastasis and age, gender, location, differentiation degree, maximum tumor diameter, T-staging or histologic type was observed (P>0.05). Multivariate analysis showed that lymph node metastasis in chest or abdomen was an independent predictor of SLN metastasis.ConclusionRLN+ is not the independent predictor for SLN metastasis. SLN should be dissected in N1-3 patients with esophageal squamous cell carcinoma without considering tumor location and T-staging. Bilateral SLN dissection should be recommended even if RLN metastasis is only unilateral.
Along with the popularity of low-dose computed tomography lung cancer screening, an increasing number of early-stage lung cancers are detected. Radical lobectomy with systematic nodal dissection (SND) remains the standard-of-care for operable lung cancer patients. However, whether SND should be performed on non-metastatic lymph nodes remains controversy. Unnecessary lymph node dissection can increase the difficulty of surgery while also causing additional surgical damage. In addition, non-metastatic lymph nodes have been recently reported to play a key role in immunotherapy. How to reduce the surgical damage of mediastinal lymph node dissection for early-stage lung cancer patients is pivotal for modern concept of "minimally invasive surgery for lung cancer 3.0". The selective mediastinal lymph node dissection strategy aims to dissect lymph nodes with tumor metastasis while preserving normal mediastinal lymph nodes. Previous studies have shown that combination of specific tumor segment site, radiology and intraoperative frozen pathology characteristics can accurately predict the pattern of mediastinal lymph node metastasis. The personalized selective mediastinal lymph node dissection strategy formed from this has been successfully validated in a recent prospective clinical trial, providing an important basis for early-stage lung cancer patients to receive more personalized selective lymph node dissection with "precision surgery" strategies.
Objective
To investigate the value of sentinel lymph node biopsy (SLNB) in predicting the metastasis of central cervical lymph nodes (CCLN) in differentiated thyroid carcinoma, and to explore reasonable program for CCLN dissection.
Methods
This retrospective analysis was performed basing on the clinical data of 407 patients with differentiated thyroid carcinoma who were admitted to the Department of General Surgery of Xuanwu Hospital from June 2013 to December 2016, including 237 patients with microcarcinoma.
Results
① The results of the lymph nodes detection. All patients had detected 7 766 lymph nodes (1 238 metastatic lymph nodes were detected from 219 patients), and 2 085 sentinel lymph nodes were detected (448 metastatic sentinel lymph nodes were detected from 189 patients). In the patients with microcarcinoma, there were 3 614 lymph nodes were detected (390 metastatic lymph nodes were detected from 97 patients), and 1 202 sentinel lymph nodes were detected (149 metastatic sentinel lymph nodes were detected from 82 patients). ② The value of SLNB to predict CCLN metastasis. The sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of SLNB to predict CCLN metastasis for all patients was 86.30% (189/219), 100% (188/188), 0 (0/189), 13.70% (30/219), 100% (189/189), and 86.24% (188/218) respectively; for patients with microcarcinoma was 84.54% (82/97), 100% (140/140), 0 (0/82), 15.46% (15/97), 100% (82/82), and 90.32% (140/155), respectively. ③ The value of SLNB to predict the presence of additional positive lymph nodes (APLN). The sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of SLNB to predict the APLN for all patients was 81.48% (132/162), 76.73% (188/245), 23.27% (57/245), 18.52% (30/162), 69.84% (132/189) and 86.24% (188/218), respectively; for patients with microcarcinoma was 73.68% (42/57), 77.78% (140/180), 22.22% (40/180), 26.32% (15/57), 51.22% (42/82) and 90.32% (140/155) respectively. ④ The value of positive sentinel lymph node ratio (PSLNR) to predict the presence of the APLN. The sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of PSLNR to predict the APLN for all patients was 71.97%, 78.95%, 21.05%, 28.03%, 88.79%, and 54.88% respectively, and the cutoff for PSLNR was 0.345 2. For patients with microcarcinoma, the sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of PSLNR to predict the APLN was 83.33%, 67.50%, 32.50%, 16.67%, 72.92%, and 79.41% respectively, and the cutoff for PSLNR was 0.291 7.
Conclusion
There is an important predicted value of SLNB for CCLN dissection in the patients suffered from differentiated thyroid carcinoma, and the PSLNR is a reliable basis for CCLN dissection.
To investigate the relationship between clinicopathological features and lymph node metastasis in the primary gastric cancer and affer the basis for deciding appropriate extent of lymph node dissection, a total of 192 patients who underwent curative gastrectomy and lymph node dissection for gastric cancer were analyzed retrospectively. Result: The total rate of lymph node metastasis was 60.4%, with 28.9% of the resected lymph nodes involved. The lymph node metastasis of C, M, A region and the whole stomach were 64.6%, 57.7%, 59.1% and 90.9% respectively. The rates of the lymph node metastasis increased successively in carcinoma of early, middle and late stages (Ｐ＜0.05), the rate of the infiltrative tumor (Borr Ⅲ，Ⅳ) being 76.5% which was significantly higher than that of the circumscribed tumor (Borr Ⅰ，Ⅱ) (43.2%)。 Relating with the tumor size ＜4cm in diameter showed lesser rate, while 4-8 cm and ＞8cm in diameter showed increasingly higher metastaticrate (Ｐ＜0.01). As a result, we should decide the appropriate extent of lymph node dissection during the operation on the basis of clinicopathological stages, type of Borrmann’s, site and maximum diameter of gastric cancer along with the state of lymph node metastasis in carcinoma of different region of the stomach.
Objective To analyze the effects of systematic lymph node dissection (SLND) and lobe-specific lymph node dissection (L-SND) on perioperative and long-term outcomes of patients with clinicalⅠA (cⅠA) stage lung adenocarcinoma. Methods A retrospective analysis was done on the patients with cⅠA stage lung adenocarcinoma who received thoracoscopic radical resection admitted to the Affiliated Hospital of Qingdao University from January 2013 to August 2016. Propensity score matching was conducted to eliminate the biases. The recurrence-free survival was compared between the two groups after matching. Perioperative parameters and postoperative complications were also analyzed. Results A total of 725 patients were enrolled, including 252 males and 473 females, with a median age of 62.0 (31.0-69.0) years. There were 228 patients in the L-SND group and 497 patients in the SLND group. After matching, there were 211 patients in each group and no statistical difference in the incidence of postoperative complications (10.9% vs. 13.7%, P=0.374), identification of metastatic positive lymph nodes (12.3% vs. 9.0%, P=0.270), or recurrence-free survival (P=0.492) were found between two groups, whereas the operation time (163.9±39.4 min vs. 135.4±32.4 min, P＜0.001), intraoperative blood loss [100.0 (20.0-800.0) mL vs. 100.0 (10.0-400.0) mL, P＜0.001], intubation time [4.0 (1.0-18.0) d vs. 4.0 (1.0-9.0) d, P＜0.001] and hospital stay (12.3±3.3 d vs. 10.8±2.4 d, P=0.003) in the SLND group were found to be significantly higher or longer than those in the L-SND group. Conclusion L-SND has a similar efficiency to SLND in terms of postoperative complications, pathological lymph node metastasis, and recurrence-free survival, as well as significant advantages in reducing intraoperative blood loss, and shortening operation time, intubation time and length of hospital stay. Therefore, L-SND can be recommended to replace SLND as a method for lymph node resection in patients with cⅠA stage lung adenocarcinoma.
Objective
To summarize the clinical and research status in the surgical management of medullary thyroid carcinoma.
Methods
The related literatures on treatment of medullary thyroid carcinoma were collected and reviewed.
Results
A total thyroidectomy and dissection of the lymph nodes in the central compartment were effective treatments for patients with medullary thyroid carcinoma. The extent of lateral compartment lymph-node dissection did not reach an agreement. Prophylactic thyroidectomy was suggested for patients with a RET (rearranged during transfection) germline mutation. Palliative therapy was the main treatment of metastatic medullary thyroid carcinoma.
Conclusions
Surgery is the mainstay of treatment for medullary thyroid carcinoma. The combination of preoperative assessment, genetic testing, and appropriate surgical strategy may improve the prognosis of patients with medullary thyroid carcinoma.
ObjectiveTo summarize the prevention and treatment strategies and their effects on lymphatic leakage following transoral endoscopic thyroid cancer lateral neck lymph node dissection. MethodsA retrospective review was conducted, we collected clinical data from 47 patients with papillary thyroid carcinoma who underwent transoral endoscopic thyroidectomy and lateral neck lymph node dissection at our hospital from January 2021 to May 2023. A stepwise sequential treatment plan was adopted for patients with postoperative lymphatic leakage: low-fat, low-protein diet, continuous strong negative pressure suction, subcutaneous injection of Group A streptococcus in the surgical cavity, and ligation of the thoracic duct or lymphatic vessels through a small incision. The effectiveness of the sequential treatment plan was summarized. ResultsOut of the 47 patients, lymphatic leakage occurred in 5 cases postoperatively. Patient No.1 was cured of lymphatic leakage after sequential treatments including pectoralis major muscle flap occlusion of the jugular venous angle, low-fat, low-protein diet, continuous strong negative pressure suction postoperatively, subcutaneous injection of Group A streptococcus in the surgical cavity, and finally ligation of the thoracic duct or lymphatic vessels through a small incision. Patient No.20 was conservatively cured of lymphatic leakage with an initial surgical procedure involving pectoralis major muscle flap occlusion of the jugular venous angle, low-fat, low-protein diet, continuous strong negative pressure suction postoperatively, and subcutaneous injection of Group A streptococcus in the surgical cavity. Patient No.28 recovered after only pectoralis major muscle flap occlusion of the jugular venous angle, low-fat, low-protein diet and continuous strong negative pressure suction postoperatively. Treatment process of patient No.30 was the same as Patient No.1, Patient No.36 was the same as Patient No.20. Through the stepwise sequential treatment measures, all 5 patients successfully recovered from lymphatic leakage; the postoperative hospital stay ranged from 3 to 17 days, with an average of 8.6 days. ConclusionsThe stepwise sequential treatment plan used in this study can effectively prevent and treat lymphatic leakage after transoral endoscopic thyroid cancer lateral neck lymph node dissection. Given the small sample size of this study, we believe that it is necessary to conduct long-term studies to confirm the durability and stability of these measures.
As a standard of care, lymph node dissection is an indispensible step in lung cancer surgery. The quality of dissection determines completeness of surgery and the accuracy of N staging. Hereby, we suggest labeling all surgically resected nodes according to the new lymph node map in the 8th TNM classification for lung cancer. As systematic lymph node dissection remains the gold standard of lymphadenectomy, at least three mediastinal stations and ten nodes should be removed in an en-bloc fashion, if possible. For patients with stage Ⅰ lung cancer, lymph node dissection via video-assisted thoracoscopic surgery (VATS) or open thoracotomy may has similar oncological outcome. Besides, limited lymph node sampling in selected patients with early staged lung cancer to minimize unnecessary surgical damage still need further investigation.
Objective To investigate the clinical effect of non inflatable endoscope assisted lateral cervical lymph node dissection in elderly patients with thyroid cancer. Methods The clinical data of 61 patients with lateral cervical lymphadenectomy assisted by non inflatable endoscope from January 2016 to December 2020 were retrospectively summarized. There were 48 females and 13 males with an average age of (71±6.5) years (range, 65–82 years). The operative time, intraoperative blood loss, cases of accessory nerve injury, cases of phrenic nerve injury, total number of lateral neck dissection lymph nodes, postoperative lymphatic leakage, postoperative drainage volume and hospital stay were counted. Neck ultrasonography and thyroglobulin levels were measured during follow-up to assess recurrence. Results All patients successfully completed the non inflatable endoscopic assisted lateral cervical lymph node dissection, the operative time was 51–117 min, the average was (92±22.1) min, the intraoperative blood loss was about 80–150 mL, the average was (120±17.1) mL, the postoperative drainage was 190–670 mL, the average was (332±167.1) mL, the postoperative hospital stay was 5–13 d, the average was (9±2.3) d, the total number of lymph nodes was 11–23, the average was (16±4.7). There were 11 cases of hypoparathyroidism, 5 cases of temporary recurrent laryngeal nerve injury, 3 cases of accessory nerve injury and no case of phrenic nerve injury. One patient had local redness and swelling after removing the drainage tube. Lymphatic leakage occurred in 3 cases. There was no recurrence during the follow-up period. Conclusion Non inflatable endoscope assisted lateral neck lymph node dissection provides technical support for elderly patients with thyroid cancer, and the effect is exact, and the short and medium-term follow-up results are satisfactory.
Objective
To compare lymph node sampling (LN-S) and lobe-specific lymph node dissection (L-SLD) in the clinical efficacy and safety for early-stage non-small cell lung cancer (NSCLC).
Methods
PubMed, Medline, EMbase, Web of Science and The Cochrane Library databases were searched up to March 2017 for English language studies. We collected randomized controlled trials (RCTs) and cohort studies (CS) which used the systematic mediastinal lymph node dissection (SMLD) and LN-S or L-SLD for the treatment of NSCLC. Direct meta-analysis was performed using RevMan 5.3 software and indirect meta-analysis with ITC software after two researchers screened the literature, extracted the data and evaluated the risk of bias independently.
Results
A total of 18 articles were included (4 RCTs and 14 CS, and 10 714 patients). Meta-analysis results showed that in the CS, compared with the the SMLD group, overall survival increased in the L-SLD group (HR=0.99, 95%CI 0.78 to 1.25, P=0.92), and overall survival decreased in the LN-S group with significant difference in CS (HR=1.43, 95%CI 1.17 to 1.75, P=0.000 4), but was not statistically significant in RCT (P=0.35). In terms of disease-free survival, there was no significant difference between the SMLD group and the LN-S group (HR=1.25, 95%CI 0.90, 1.62, P=0.10) as well as the L-SLD group (HR=1.15, 95%CI 0.92 to 1.43, P=0.23) in the CS. There was no significant difference in the local recurrence rate or distant metastasis rate between the non-systematic lymph node dissection (NSMLD) and SMLD in CS and RCTs (CS: P=0.43, P=0.39; RCT: P=0.43, P=0.10). There was no significant difference in the postoperative complications between NSMLD and SMLD in the CS (OR=0.79, 95%CI0.58 to 1.09, P=0.15) and RCTs (OR=0.36, 95%CI 0.09 to 1.45, P=0.15). Indirect meta-analysis showed that risk of death decreased by 31% and risk of recurrence by 35% in the L-SLD group compared with the LN-S group (HR=0.69, 95% CI 0.51 to 0.95, P=0.46; HR=0.65, 95% CI 0.65 to 1.30, P=0.72), but the difference was not statistically significant.
Conclusion
For early-stage NSCLC, L-SLD is not statistically different from SMLD in terms of survival; however, the overall survival of LN-S is lower than that of systematic lymphadenectomy. Indirect meta-analysis shows that L-SLD reduces the risk of death and recurrence risk compared with LN-S. There is no evidence to support both direct comparison of the prognosis of LN-S and L-SLD, therefore further prospective studies are still needed to verify.
