Introduction:We examined the pathology and safety outcomes associated with the extent of pelvic lymph node dissection in patients with high-risk prostate cancer undergoing radical prostatectomy.Materials and Methods:W...Introduction:We examined the pathology and safety outcomes associated with the extent of pelvic lymph node dissection in patients with high-risk prostate cancer undergoing radical prostatectomy.Materials and Methods:We retrospectively identified men with prostate cancer who underwent robot-assisted radical prostatectomy with pelvic lymph node dissection between May 2016 and September 2021.Cases were categorized using Current Procedural Terminology(CPT)codes(38571)for extended lymph node dissection and super-extended lymph node dissection(38572).Using logistic regression,we compared the groups on a number of factors,including recurrence.Results:Super-extended lymph node dissection had significantly higher median prostate-specific antigen and National Comprehensive Cancer Network risk classification prior to surgery.Significant differences were observed in the pathologic T stage and pathology grade group.Time on robot was significantly longer for the super-extended group,while estimated blood loss was lower.No differences were observed in length of stay or any complication-related variable.Super-extended had significantly higher node positivity(36.1%vs.7.6%,p<0.001)and recurrence.10.0%of super-extended cases had node positivity in the aortic bifurcation,the common iliac,or the pre-sacral chains that would have been missed with an extended dissection.2.2%of patients had node positivity in these chains only.Conclusions:Super-extended lymph node dissection is safe and feasible for patients with high-risk prostate cancer.Further research is needed to better understand its clinical benefit and to further inform optimal patient selection.展开更多
The current status and future prospects for diagnosis and treatment of lateral pelvic lymph node(LPLN)metastasis of rectal cancer are described in this review.Magnetic resonance imaging(MRI)is recommended for the diag...The current status and future prospects for diagnosis and treatment of lateral pelvic lymph node(LPLN)metastasis of rectal cancer are described in this review.Magnetic resonance imaging(MRI)is recommended for the diagnosis of LPLN metastasis.A LPLN-positive status on MRI is a strong risk factor for metastasis,and evaluation by MRI is important for deciding treatment strategy.LPLN dissection(LPLD)has an advantage of reducing recurrence in the lateral pelvis but also has a disadvantage of complications;therefore,LPLD may not be appropriate for cases that are less likely to have LPLN metastasis.Radiation therapy(RT)and chemoradiation therapy(CRT)have limited effects in cases with suspected LPLN metastasis,but a combination of preoperative CRT and LPLD may improve the treatment outcome.Thus,RT and CRT plus selective LPLD may be a rational strategy to omit unnecessary LPLD and produce a favorable treatment outcome.展开更多
Significant controversies exist with regards to the optimal management of lateral pelvic lymph nodes metastases(mLLN)in patients with low rectal cancer.The differing views held by Japanese and Western clinicians on th...Significant controversies exist with regards to the optimal management of lateral pelvic lymph nodes metastases(mLLN)in patients with low rectal cancer.The differing views held by Japanese and Western clinicians on the management of mLLN have been well documented.However,the adequacy of pelvic lymph node dissection(PLND)or neoadjuvant chemoradiation(NACRT)alone in addition to total mesorectal excision(TME)have recently come into question,due to the relatively high incidence of lateral local recurrences following PLND and TME,or NACRT and TME alone.Recently,a more selective approach to PLND has been suggested,involving a combination of neoadjuvant therapy,followed by PLND only to patients in whom the oncological benefit is likely to outweigh the risk of potential adverse events.A number of studies have attempted to retrospectively identify certain nodal characteristics on preoperative imaging,such as nodal size,appearance,and size reduction following neoadjuvant therapy.However,no consensus has been reached regarding the optimal criteria for a selective approach to PLND,partly due to the heterogeneity and retrospective nature of most of these studies.This review aims to provide an overview of recent evidence with regards to the diagnostic challenges,considerations for,and outcomes of the current management strategies for mLLN in rectal cancer patients.展开更多
Colorectal cancer ranks among the most commonly diagnosed cancers globally,and is associated with a high rate of pelvic recurrence after surgery.In efforts to mitigate recurrence,pelvic lymph node dissection(PLND)is c...Colorectal cancer ranks among the most commonly diagnosed cancers globally,and is associated with a high rate of pelvic recurrence after surgery.In efforts to mitigate recurrence,pelvic lymph node dissection(PLND)is commonly advocated as an adjunct to radical surgery.Neoadjuvant chemoradiotherapy(NACRT)is a therapeutic approach employed in managing locally advanced rectal cancer,and has been found to increase the survival rates.Chua et al have proposed a combination of NACRT with selective PLND for addressing lateral pelvic lymph node metastases in rectal cancer patients,with the aim of reducing recurrence and improving survival outcomes.Nevertheless,certain studies have indicated that the addition of PLND to NACRT and total mesorectal excision did not yield a significant reduction in local recurrence rates or improvement in survival.Consequently,meticulous patient selection and perioperative chemotherapy may prove indispensable in ensuring the efficacy of PLND.展开更多
In this editorial,we proceed to comment on the article by Chua et al,addressing the management of metastatic lateral pelvic lymph nodes(mLLN)in stage II/III rectal cancer patients below the peritoneal reflection.The t...In this editorial,we proceed to comment on the article by Chua et al,addressing the management of metastatic lateral pelvic lymph nodes(mLLN)in stage II/III rectal cancer patients below the peritoneal reflection.The treatment of this nodal area sparks significant controversy due to the strategic differences followed by Eastern and Western physicians,albeit with a higher degree of convergence in recent years.The dissection of lateral pelvic lymph nodes without neoadjuvant therapy is a standard practice in Eastern countries.In contrast,in the West,preference leans towards opting for neoadjuvant therapy with chemoradiotherapy or radiotherapy,that would cover the treatment of this area without the need to add the dissection of these nodes to the total mesorectal excision.In the presence of high-risk nodal characteristics for mLLN related to radiological imaging and lack of response to neoadjuvant therapy,the risk of lateral local recurrence increases,suggesting the appropriate selection of strategies to reduce the risk of recurrence in each patient profile.Despite the heterogeneous and retrospective nature of studies addressing this area,an international consensus is necessary to approach this clinical scenario uniformly.展开更多
BACKGROUND As one effective treatment for lateral pelvic lymph node(LPLN)metastasis(LPNM),laparoscopic LPLN dissection(LPND)is limited due to the complicated anatomy of the pelvic sidewall and various complications af...BACKGROUND As one effective treatment for lateral pelvic lymph node(LPLN)metastasis(LPNM),laparoscopic LPLN dissection(LPND)is limited due to the complicated anatomy of the pelvic sidewall and various complications after surgery.With regard to improving the accuracy and completeness of LPND as well as safety,we tried an innovative method using indocyanine green(ICG)visualized with a near-infrared(NIR)camera system to guide the detection of LPLNs in patients with middle-low rectal cancer.AIM To investigate whether ICG-enhanced NIR fluorescence-guided imaging is a better technique for LPND in patients with rectal cancer.METHODS A total of 42 middle-low rectal cancer patients with clinical LPNM who underwent total mesorectal excision(TME)and LPND between October 2017 and March 2019 at our institution were assessed and divided into an ICG group and a non-ICG group.Clinical characteristics,operative outcomes,pathological outcomes,and postoperative complication information were compared and analysed between the two groups.RESULTS Compared to the non-ICG group,the ICG group had significantly lower intraoperative blood loss(55.8±37.5 mL vs 108.0±52.7 mL,P=0.003)and a significantly larger number of LPLNs harvested(11.5±5.9 vs 7.1±4.8,P=0.017).The LPLNs of two patients in the non-IVG group were residual during LPND.In addition,no significant difference was found in terms of LPND,LPNM,operative time,conversion to laparotomy,preoperative complication,or hospital stay(P>0.05).CONCLUSION ICG-enhanced NIR fluorescence-guided imaging could be a feasible and convenient technique to guide LPND because it could bring specific advantages regarding the accuracy and completeness of surgery as well as safety.展开更多
AIM To assess the clinical significance of prophylactic lateral pelvic lymph node dissection (LPLND) in stage Ⅳ low rectal cancer.METHODS We selected 71 consecutive stage Ⅳ low rectal cancer patients who underwent p...AIM To assess the clinical significance of prophylactic lateral pelvic lymph node dissection (LPLND) in stage Ⅳ low rectal cancer.METHODS We selected 71 consecutive stage Ⅳ low rectal cancer patients who underwent primary tumor resection,and enrolled 50 of these 71 patients without clinical LPLN metastasis.The patients had distant metastasis such as liver,lung,peritoneum,and paraaortic LN.Clinical LPLN metastasis was defined as LN with a maximum diameter of 10 mm or more on preoperative pelvic computed tomography scan.All patients underwent primary tumor resection,27 patients underwent total mesorectal excision(TME) with LPLND(LPLND group),and 23 patients underwent only TME(TME group).Bilateral LPLND was performed simultaneously with primary tumor resection in LPLND group.R0 resection of both primary and metastatic sites was achieved in 20 of 50 patients.We evaluated possible prognostic factors for 5-year overall survival (OS),and compared 5-year cumulative local recurrence between the LPLND and TME groups.RESULTS For OS,univariate analyses revealed no significant benefit in the LPLND compared with the TME group (28.7% vs 17.0%,P = 0.523); multivariate analysis revealed that R0 resection was an independent prognostic factor.Regarding cumulative local recurrence,the LPLND group showed no significant benefit compared with TME group (21.4% vs 14.8%,P = 0.833).CONCLUSION Prophylactic LPLND shows no oncological benefits in patients with Stage Ⅳ low rectal cancer without clinical LPLN metastasis.展开更多
Objective This study aimed to compare and analyze the clinical efficacy and safety of late-course and simultaneous integrated dose-increasing intensity-modulated radiation therapy(IMRT) for cervical cancer complicated...Objective This study aimed to compare and analyze the clinical efficacy and safety of late-course and simultaneous integrated dose-increasing intensity-modulated radiation therapy(IMRT) for cervical cancer complicated with pelvic lymph node metastasis. Methods Sixty patients with cervical cancer complicated with pelvic lymph node metastasis who were admitted to our hospital from January 2013 to January 2015 were enrolled. The patients were randomly divided into the late-course dose-increasing IMRT group and the simultaneous integrated dose-increasing IMRT group, with 30 cases included in each group, respectively. All patients were concurrently treated with cisplatin. After treatment, the clinical outcomes of the two groups were compared. Results The remission rate of symptoms in the simultaneous integrated dose-increasing IMRT group was significantly higher than that in the late-course dose-increasing IMRT group(P < 0.05). The follow-up results showed that the overall survival time, progression-free survival time, and distant metastasis time of patients in the simultaneous integrated dose-increasing IMRT group were significantly longer than those in the late-course dose-increasing IMRT group(P < 0.05). The recurrent rate of lymph nodes in the radiation field in the simultaneous integrated dose-increasing IMRT group was significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group. There was no significant difference in the incidence of cervical and vaginal recurrence and distant metastasis between the two groups(P > 0.05). The radiation doses of Dmax in the small intestine, D1 cc(the minimum dose to the 1 cc receiving the highest dose) in the bladder, and Dmax in the rectum in the simultaneous integrated dose-increasing IMRT group were significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group. There was no significant difference in intestinal D2 cc(the minimum dose to the 2 cc receiving the highest dose) between the two groups(P > 0.05). The incidence of bone marrow suppression in the simultaneous integrated dose-increasing IMRT group was significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group.Conclusion The application of simultaneous integrated dose-increasing IMRT in the treatment of cervical cancer patients complicated with pelvic lymph node metastasis can significantly control tumor progression, improve the long-term survival time, and postpone distant metastasis time with high safety.展开更多
Background/Aims:Current guidelines suggest that the indications for pelvic lymph node(LN)dissection(PLND)during radical pros-tatectomy(RP)should rely on nomograms predicting their involvement.Positron emission tomogra...Background/Aims:Current guidelines suggest that the indications for pelvic lymph node(LN)dissection(PLND)during radical pros-tatectomy(RP)should rely on nomograms predicting their involvement.Positron emission tomography/computed tomography(PET/CT)with prostate-specific membrane antigen(PSMA)radioligand is gaining acceptance as routine diagnostic test before RP in patients with intermediate/high-risk prostate cancer(PC).In this study,we examined the effect of preoperative PET/CT on the accuracy of the nomograms.Materials and methods:Patients with intermediate/high risk PC showing no extraprostatic disease on PET/CT-PSMA underwent RP with PLND and were followed postoperatively for at least 6 months.Patients with detectable(>0.1 ng/mL)postoperative prostate-specific antigen levels underwent re-evaluation with PET/CT-PSMA.Results:A total of 70 patients underwent RP for intermediate(34 patients)or high-risk disease(36 patients).According to the Partin,MSKCC,and Briganti 2012 nomograms,positive LNs were expected in 7,13,and 12 patients,respectively.At PLND,1 positive LN was found in a single patient(p<0.05 compared with the expected number of patients from all nomograms).Postoperatively,10 pa-tients developed detectable prostate-specific antigen levels.One patient exhibited radioligand uptake that could indicate LN involve-ment.Considering these 2 patients as failures,the negative predictive value of PSMA-PET/CT for LN involvement was 97.1%.Conclusions:Preoperative PSMA-PET/CT with no extraprostatic uptake before RP in patients with intermediate to high-grade PC is highly accurate for ruling out LN involvement,superior to the routinely used nomograms.Its use induced stage migration,rendering pre-dictive nomograms irrelevant.展开更多
Background：Pelvic lymph node metastasis （LNM） is an important prognostic factor in cervical cancer.Cervical squamous cell carcinoma accounts for approximately 75-80% of all cervical cancers.Analyses of the effects ...Background：Pelvic lymph node metastasis （LNM） is an important prognostic factor in cervical cancer.Cervical squamous cell carcinoma accounts for approximately 75-80% of all cervical cancers.Analyses of the effects of the number of positive lymph nodes （LNs）,unilateral vcrsus bilateral pelvic LNM and a single group versus multiple groups of pelvic LNM on survival and recurrence of cervical squamous cell carcinoma are still lacking.The study aimed to analyze the effects of the number of positive pelvic LNs and a single group versus multiple groups of pelvic LNM on survival and recurrence.Methods：We performed a retrospective review of 296 patients diagnosed with Stage ⅠA-ⅡB cervical squamous cell carcinoma who received extensive/sub-extensive hysterectomy with pelvic lymphadenectomy/pelvic LN sampling at Peking University People＇s Hospital from November 2004 to July 2013.Ten clinicopathological variables were evaluated as risk factors for pelvic LNM：Age at diagnosis,gravidity,clinical stage,histological grade,tumor diameter,lymph-vascular space involvement （LVSI）,depth of cervical stromal invasion,uterine invasion,parametrial invasion,and neoadjuvant chemotherapy.Results：The incidence of pelvic LNM was 20.27% （60/296 cases）.Pelvic LNM （P =0.00） was significantly correlated with recurrence.Pelvic LNM （P =0.00）,the number of positive pelvic LNs （P =0.04） and a single group versus multiple groups of pelvic LNM （P =0.03）had a significant influence on survival.Multivariate analysis revealed that LVSI （P =0.00）,depth of cervical stromal invasion （P =0.00）and parametrial invasion （P =0.03） were independently associated with pelvic LNM.Conclusions：Patients with pelvic LNM had a higher recurrence rate and poor survival outcomes.Furthermore,more than 2 positive pelvic LNs and multiple groups of pelvic LNM appeared to identify patients with worse survival outcomes in node-positive ⅠA-ⅡB cervical squamous cell carcinoma.LVSI,parametrial invasion,and depth of cervical stromal invasion were identified as independent clinicopathological risk factors for pelvic LNM.展开更多
Background The reproducibility of positron emission tomography(PET)radiomics features is affected by several factors,such as scanning equipment,drug metabolism time and reconstruction algorithm.We aimed to explore the...Background The reproducibility of positron emission tomography(PET)radiomics features is affected by several factors,such as scanning equipment,drug metabolism time and reconstruction algorithm.We aimed to explore the role of 3D local binary pattern(LBP)-based texture in increasing the accuracy and reproducibility of PET radiomics for predicting pelvic lymph node metastasis(PLNM)in patients with cervical cancer.Methods We retrospectively analysed data from 177 patients with cervical squamous cell carcinoma.They un-derwent18 F-fluorodeoxyglucose(18 F-FDG)whole-body PET/computed tomography(PET/CT),followed by pelvic 18 F-FDG PET/magnetic resonance imaging(PET/MR).We selected reproducible and informative PET radiomics features using Lin’s concordance correlation coefficient,least absolute shrinkage and selection operator algorithm,and established 4 models,PET/CT,PET/CT-fusion,PET/MR and PET/MR-fusion,using the logistic regression al-gorithm.We performed receiver operating characteristic(ROC)curve analysis to evaluate the models in the training data set(65 patients who underwent radical hysterectomy and pelvic lymph node dissection)and test data set(112 patients who received concurrent chemoradiotherapy or no treatment).The DeLong test was used for pairwise comparison of the ROC curves among the models.Results The distribution of age,squamous cell carcinoma(SCC),International Federation of Gynaecology and Obstetrics stage and PLNM between the training and test data sets were different(P<0.05).The LBP-transformed radiomics features(50/379)had higher reproducibility than the original radiomics features(9/107).Accuracy of each model in predicting PLNM was as follows:training data set:PET/CT=PET/CT-fusion=PET/MR-fusion(0.848)and test data set:PET/CT=PET/CT-fusion(0.985)>PET/MR=PET/MR-fusion(0.954).There was no statistical difference between the ROC curve of PET/CT and PET/MR models in both data sets(P>0.05).Conclusions The LBP-transformed radiomics features based on PET images could increase the accuracy and reproducibility of PET radiomics in predicting pelvic lymph node metastasis in cervical cancer to allow the model to be generalised for clinical use across multiple centres.展开更多
Background:Radical prostatectomy(RP)and radical cystectomy(RC)with concurrent pelvic lymph node dissection(PLND)are considered as the curative surgical treatment options for localized prostate cancer(PC)or muscle-inva...Background:Radical prostatectomy(RP)and radical cystectomy(RC)with concurrent pelvic lymph node dissection(PLND)are considered as the curative surgical treatment options for localized prostate cancer(PC)or muscle-invasive bladder cancer(BC).Regarding lymphatic leakage management after PLND,there is no standard of care,with different therapeutic approaches having been reported with varying success rates.Methods:Seventy patients underwent pelvic lymphadenectomy during robotic RP and RC with postoperative pelvic drainage volume more than 50 mL/day before the removal of drainage tube,were retrospectively evaluated in this study between August 2015 and June 2023.If the pelvic drainage volume on postoperative Day 2 was more than 50 mL/day,a drainage fluid creatinine was routinely tested to rule out urine leakage.We removed the drainage if the patient had no significant abdominal free fluid collection,no abdominal distension or pain,no fever,and no abdominal tenderness.After 1-day observation of the vital signs and abdominal symptoms,the patient was discharged and followed-up in clinic for 2 weeks after surgery.Results:Forty-one cases underwent the early drainage removal even if the pelvic drainage volume was more than 50mL/day.Among these forty-one cases,twenty-five drainage tubes were removed when drainage volume was more than 100 mL/day.All the forty-one cases with pelvic drainage volume greater than 50mL/day were successfully managed with the early drainage removal.No paracentesis or drainage placement was required.No readmission occured during the follow-up period.Conclusion:It is safe to manage the high-volume pelvic lymphatic leakage by early clamping of the drainage tube,ultrasonography assessment of no significant residual fluid in the abdominal and pelvic cavity,and then the early removal of the drainage tube.展开更多
Background:Pelvic lymph node dissection(PLND)in radical cystectomy(RC)is of great significance,but the method and scope of PLND remain controversial.Based on the principle of indirect lymphadenography,we designed a me...Background:Pelvic lymph node dissection(PLND)in radical cystectomy(RC)is of great significance,but the method and scope of PLND remain controversial.Based on the principle of indirect lymphadenography,we designed a method to localize the whole pelvic lymph nodes by intradermal injection of indocyanine green(ICG)through the lower limbs and perineum,and to evaluate the effectiveness of this method. Methods:In a single center,54 bladder cancer patients who underwent RC and PLND participated in a prospective clinical trial,which began on February 28,2022 and ended on December 30,2022.ICG solution was injected subcutaneously at the medial malleolus of both lower extremities and at both sides of the midline of the perineum.The fluorescent laparoscopy was used to trace,locate,and remove the targeted areas under the image fusion mode.The consistency of lymph node resection was determined by histopathological diagnosis.The impact of ICG guidance on the surgical time of PLND was compared with that of 11 bladder cancer patients who underwent RC and PLND without ICG injection,serving as the control group. Results:Perineal lower limb combined injection can provide comprehensive visualization of pelvic lymph nodes.This technique reduces PLND surgical time and increases the accuracy of PLND. Conclusion:Intracutaneous injection of ICG into the lower limbs and perineum can specifically mark pelvic lymph nodes.Intraoperative fluores-cence imaging can accurately identify,locate,and resect lymph nodes in the pelvic region,reducing PLND surgical time and increasing the accuracy of PLND.展开更多
Background:The National Comprehensive Cancer Network(NCCN)guidelines recommend pelvic lymph node dissection(PLND)in NCCN high-and intermediate-risk prostate cancer patients.We tested for PLND nonadherence(no-PLND)rate...Background:The National Comprehensive Cancer Network(NCCN)guidelines recommend pelvic lymph node dissection(PLND)in NCCN high-and intermediate-risk prostate cancer patients.We tested for PLND nonadherence(no-PLND)rates within the Surveillance Epidemiology and End Results(2010-2015).Materials and methods:We identified all radical prostatectomy patients who fulfilled the NCCN PLND guideline criteria(n=23,495).Nonadherence rates to PLND were tabulated and further stratified according to NCCN risk subgroups,race/ethnicity,geographic distribution,and year of diagnosis.Results:Overall,the no-PLND rate was 26%;it was 41%,25%,and 11%in the NCCN intermediate favorable,intermediate unfavorable,and high-risk prostate cancer patients,respectively(p<0.001).Overtime,the no-PLND rates declined in the overall cohort and within each NCCN risk subgroup.Georgia exhibited the highest no-PLND rate(49%),whereas New Jersey exhibited the lowest(15%).Finally,no-PLND race/ethnicity differences were recorded only in the NCCN intermediate unfavorable subgroup,where Asians exhibited the lowest no-PLND rate(20%)versus African Americans(27%)versus Whites(26%)versus Hispanic-Latinos(25%).Conclusions:The lowest no-PLND rates were recorded in the NCCN high-risk patients followed by NCCN intermediate unfavorable and favorable risk in that order.Our findings suggest that unexpectedly elevated differences in no-PLND rates warrant further examination.In all the NCCN risk subgroups,the no-PLND rates decreased over time.展开更多
Extended pelvic lymphadenectomy(EPL) with total mesorectal excision(TME) has been reported to provide oncological benefit in lower rectal cancer in Japan.In Western countries EPL is not widely accepted because of freq...Extended pelvic lymphadenectomy(EPL) with total mesorectal excision(TME) has been reported to provide oncological benefit in lower rectal cancer in Japan.In Western countries EPL is not widely accepted because of frequent morbidity but instead preoperative chemoradiation(CRT) followed by TME has been established as a standard treatment for decreasing local recurrence.Recently,several studies have focused on the comparison between these two distinct therapeutic approaches in Western countries and Japan.A study comparing Dutch trial data and Japanese data revealed that EPL and RT are almost equivalent in decreasing local recurrence in lower rectal cancer as compared with TME alone.Considering that almost 45 survival can be achieved by EPL even in the presence of metastatic lateral lymph nodes(LLNs),EPL performed by experienced surgeons definitely contributes to decrease local recurrence.On the other hand,a randomized controlled trial in Japan that compared EPL with conventional TME following preoperative RT revealed that EPL is associated with a higher frequency of sexual and urinary dysfunction without oncological benefits in the presence of preoperative RT.On this point,preoperative CRT followed by conventional TME without EPL would be a better therapeutic approach in patients without evident metastatic LLNs.For future treatment,it would be desirable to have a narrower indication for EPL using full advantage of recent improvement in image diagnosis.Although objective comparison of these two principles between Japan and the West is difficult due to differences in patient groups,further studies would lead to the next great step towards future improvement in treating lower rectal cancer.展开更多
Objective: To assess the value of sentinel lymph node (SLN) localization by lymphoscintigraphy and gamma probe detection in early cervical cancer. Methods: A total of 27 patients with operable invasive early cervical ...Objective: To assess the value of sentinel lymph node (SLN) localization by lymphoscintigraphy and gamma probe detection in early cervical cancer. Methods: A total of 27 patients with operable invasive early cervical cancer and clinically proved negative pelvic lymph nodes were included in this study. The 99Tcm-dextran of 74 MBq (2 mCi) was injected around the cervix at 2 and 10. Lymphoscintigraphy and gamma probe detection were used to find the SLN. Results: The SLN was identified in 27 patients. The sensitivity and specificity of the SLN detection to predict the metastasis of the pelvic lymph node were 100% and 100% respectively. Conclusion: Identification of the SLN using radionuclide is feasible and possible in women with early cervical cancer.展开更多
BACKGROUND Lateral pelvic lymph node(LLN)metastasis(LLNM)occur in up to 28%of patients with low rectal tumours.While prophylactic lateral pelvic lymph node dissection(LLND)has been abandoned by most western institutio...BACKGROUND Lateral pelvic lymph node(LLN)metastasis(LLNM)occur in up to 28%of patients with low rectal tumours.While prophylactic lateral pelvic lymph node dissection(LLND)has been abandoned by most western institutions in the era of neoadjuvant chemoradiation therapy(CRT),the role of selective LLND in patients with enlarged LLN on pre-CRT imaging remains unclear.Some studies have shown improved survival and recurrence outcomes when LLNs show"response"to CRT.However,no management algorithm exists to differentiate treatment for"responders"vs"non-responders".AIM To determine if selective LLND in patients with enlarged LLNs results in improved survival and recurrence outcomes.METHODS A systemic search of Pub Med and Embase databases for studies reporting on patients with synchronous radiologically suspicious LLNM(s-LLNM)in rectal cancer receiving preoperative-CRT was performed.RESULTS Fifteen retrospective,single-centre studies were included.793 patients with sLLNM were evaluated:456 underwent TME while 337 underwent TME with7,LLND post-CRT.In the TME group,local recurrence(LR)rates range from 12.5%to 36%.Five-year disease free survival(DFS)was 42%to 75%.In the TME with LLND group,LR rates were 0%to 6%.Five years DFS was 41.2%to 100%.Radiological response was seen in 58%.Pathologically positive LLN was found in up to 94%of non-responders vs 0%to 20%in responders.Young age,low tumour location and radiological non-response were associated with final positive LLNM and lowered DFS.CONCLUSION LLND is associated with local control in patients with s-LLNM.It can be performed in radiological non-responders given a large majority represent true LLNM.Its role in radiological responders should be considered in selected high risk patients.展开更多
The clearance of lesions during surgery for colorectal cancer encompasses the removal of both the primary tumour and its concomitant lymphatic drainage.Huge strides have been made in identifying the precise location o...The clearance of lesions during surgery for colorectal cancer encompasses the removal of both the primary tumour and its concomitant lymphatic drainage.Huge strides have been made in identifying the precise location of not only the primary tumour,but also the lymph nodes(LNs),owing to the use of intraoperative navigation techniques.Among these techniques,indocyanine green-enhanced fluorescence imaging(ICG-FI)has revolutionized colorectal oncologic surgery by providing clear visualization during lymphangiography.ICG-FI has emerged as a powerful tool for sentinel lymph node procedures that allows for local excision instead of radical D3 lymphadenectomy.It also makes it possible to identify potential metastatic lateral pelvic lymph nodes,which enables simultaneous lymphadenectomy of the pelvic side-wall during the resection of middle-lower rectal cancer.This review provides an update on the current use of and research on ICG-FI-guided LNs mapping for colorectal malignancies,and also discusses its drawbacks and future prospects.展开更多
To the Editor:Cervical cancer(CC)is the second leading cause of cancer death in women,representing a major global health challenge.[1]Cervical squamous cell carcinoma(CSCC)accounts for 70%of CC cases,and pelvic lymph ...To the Editor:Cervical cancer(CC)is the second leading cause of cancer death in women,representing a major global health challenge.[1]Cervical squamous cell carcinoma(CSCC)accounts for 70%of CC cases,and pelvic lymph node metastasis is a critical cause of CC-related death.[2]Thus,understanding the underlying mechanisms of the tumor spread through lymphatic vessels becomes imperative.[3]RNA helicases are involved in almost all aspects of RNA metabolism.[4]DEAD-box helicase 24(DDX24),one of the least explored DEAD-box RNA helicases,was upregulated in several cancer types.[5]However,the role of DDX24 in CSCC progression and metastasis remains elusive.Here,we investigated the essential role of DDX24 in mediating cancer cell EMT and lymphangiogenesis in the context of CSCC.Our study provides a potential therapeutic target for CSCC lymphatic metastasis.展开更多
目的探讨早期宫颈癌、子宫内膜癌、卵巢癌术中保留腹股沟深淋巴结是否可以减轻术后下肢淋巴水肿。方法采用前瞻性随机对照研究设计,纳入2022年7月~2023年7月早期宫颈癌、子宫内膜癌、卵巢癌100例,随机分为保留组(保留腹股沟深淋巴结,n=...目的探讨早期宫颈癌、子宫内膜癌、卵巢癌术中保留腹股沟深淋巴结是否可以减轻术后下肢淋巴水肿。方法采用前瞻性随机对照研究设计,纳入2022年7月~2023年7月早期宫颈癌、子宫内膜癌、卵巢癌100例,随机分为保留组(保留腹股沟深淋巴结,n=50)和切除组(切除腹股沟深淋巴结,n=50)。均由同一手术团队行根治性手术。术后1、2、6、12个月评估下肢淋巴水肿情况,采用妇科恶性肿瘤淋巴水肿问卷(Gynecologic Cancer Lymphedema Questionnaire,GCLQ)和下肢周径测量进行诊断。结果保留组下肢淋巴水肿发生率6%(3/50),显著低于切除组的20%(10/50)(χ^(2)=4.332,P=0.037),且发生时间较晚[(5.3±3.1)月vs.(2.3±1.6)月,t=2.394,P=0.036],2组下肢淋巴水肿分期和部位差异无显著性(P>0.05)。结论在早期宫颈癌、子宫内膜癌及卵巢癌手术中保留腹股沟深淋巴结可显著降低术后下肢淋巴水肿的发生率。展开更多
文摘Introduction:We examined the pathology and safety outcomes associated with the extent of pelvic lymph node dissection in patients with high-risk prostate cancer undergoing radical prostatectomy.Materials and Methods:We retrospectively identified men with prostate cancer who underwent robot-assisted radical prostatectomy with pelvic lymph node dissection between May 2016 and September 2021.Cases were categorized using Current Procedural Terminology(CPT)codes(38571)for extended lymph node dissection and super-extended lymph node dissection(38572).Using logistic regression,we compared the groups on a number of factors,including recurrence.Results:Super-extended lymph node dissection had significantly higher median prostate-specific antigen and National Comprehensive Cancer Network risk classification prior to surgery.Significant differences were observed in the pathologic T stage and pathology grade group.Time on robot was significantly longer for the super-extended group,while estimated blood loss was lower.No differences were observed in length of stay or any complication-related variable.Super-extended had significantly higher node positivity(36.1%vs.7.6%,p<0.001)and recurrence.10.0%of super-extended cases had node positivity in the aortic bifurcation,the common iliac,or the pre-sacral chains that would have been missed with an extended dissection.2.2%of patients had node positivity in these chains only.Conclusions:Super-extended lymph node dissection is safe and feasible for patients with high-risk prostate cancer.Further research is needed to better understand its clinical benefit and to further inform optimal patient selection.
文摘The current status and future prospects for diagnosis and treatment of lateral pelvic lymph node(LPLN)metastasis of rectal cancer are described in this review.Magnetic resonance imaging(MRI)is recommended for the diagnosis of LPLN metastasis.A LPLN-positive status on MRI is a strong risk factor for metastasis,and evaluation by MRI is important for deciding treatment strategy.LPLN dissection(LPLD)has an advantage of reducing recurrence in the lateral pelvis but also has a disadvantage of complications;therefore,LPLD may not be appropriate for cases that are less likely to have LPLN metastasis.Radiation therapy(RT)and chemoradiation therapy(CRT)have limited effects in cases with suspected LPLN metastasis,but a combination of preoperative CRT and LPLD may improve the treatment outcome.Thus,RT and CRT plus selective LPLD may be a rational strategy to omit unnecessary LPLD and produce a favorable treatment outcome.
文摘Significant controversies exist with regards to the optimal management of lateral pelvic lymph nodes metastases(mLLN)in patients with low rectal cancer.The differing views held by Japanese and Western clinicians on the management of mLLN have been well documented.However,the adequacy of pelvic lymph node dissection(PLND)or neoadjuvant chemoradiation(NACRT)alone in addition to total mesorectal excision(TME)have recently come into question,due to the relatively high incidence of lateral local recurrences following PLND and TME,or NACRT and TME alone.Recently,a more selective approach to PLND has been suggested,involving a combination of neoadjuvant therapy,followed by PLND only to patients in whom the oncological benefit is likely to outweigh the risk of potential adverse events.A number of studies have attempted to retrospectively identify certain nodal characteristics on preoperative imaging,such as nodal size,appearance,and size reduction following neoadjuvant therapy.However,no consensus has been reached regarding the optimal criteria for a selective approach to PLND,partly due to the heterogeneity and retrospective nature of most of these studies.This review aims to provide an overview of recent evidence with regards to the diagnostic challenges,considerations for,and outcomes of the current management strategies for mLLN in rectal cancer patients.
文摘Colorectal cancer ranks among the most commonly diagnosed cancers globally,and is associated with a high rate of pelvic recurrence after surgery.In efforts to mitigate recurrence,pelvic lymph node dissection(PLND)is commonly advocated as an adjunct to radical surgery.Neoadjuvant chemoradiotherapy(NACRT)is a therapeutic approach employed in managing locally advanced rectal cancer,and has been found to increase the survival rates.Chua et al have proposed a combination of NACRT with selective PLND for addressing lateral pelvic lymph node metastases in rectal cancer patients,with the aim of reducing recurrence and improving survival outcomes.Nevertheless,certain studies have indicated that the addition of PLND to NACRT and total mesorectal excision did not yield a significant reduction in local recurrence rates or improvement in survival.Consequently,meticulous patient selection and perioperative chemotherapy may prove indispensable in ensuring the efficacy of PLND.
文摘In this editorial,we proceed to comment on the article by Chua et al,addressing the management of metastatic lateral pelvic lymph nodes(mLLN)in stage II/III rectal cancer patients below the peritoneal reflection.The treatment of this nodal area sparks significant controversy due to the strategic differences followed by Eastern and Western physicians,albeit with a higher degree of convergence in recent years.The dissection of lateral pelvic lymph nodes without neoadjuvant therapy is a standard practice in Eastern countries.In contrast,in the West,preference leans towards opting for neoadjuvant therapy with chemoradiotherapy or radiotherapy,that would cover the treatment of this area without the need to add the dissection of these nodes to the total mesorectal excision.In the presence of high-risk nodal characteristics for mLLN related to radiological imaging and lack of response to neoadjuvant therapy,the risk of lateral local recurrence increases,suggesting the appropriate selection of strategies to reduce the risk of recurrence in each patient profile.Despite the heterogeneous and retrospective nature of studies addressing this area,an international consensus is necessary to approach this clinical scenario uniformly.
文摘BACKGROUND As one effective treatment for lateral pelvic lymph node(LPLN)metastasis(LPNM),laparoscopic LPLN dissection(LPND)is limited due to the complicated anatomy of the pelvic sidewall and various complications after surgery.With regard to improving the accuracy and completeness of LPND as well as safety,we tried an innovative method using indocyanine green(ICG)visualized with a near-infrared(NIR)camera system to guide the detection of LPLNs in patients with middle-low rectal cancer.AIM To investigate whether ICG-enhanced NIR fluorescence-guided imaging is a better technique for LPND in patients with rectal cancer.METHODS A total of 42 middle-low rectal cancer patients with clinical LPNM who underwent total mesorectal excision(TME)and LPND between October 2017 and March 2019 at our institution were assessed and divided into an ICG group and a non-ICG group.Clinical characteristics,operative outcomes,pathological outcomes,and postoperative complication information were compared and analysed between the two groups.RESULTS Compared to the non-ICG group,the ICG group had significantly lower intraoperative blood loss(55.8±37.5 mL vs 108.0±52.7 mL,P=0.003)and a significantly larger number of LPLNs harvested(11.5±5.9 vs 7.1±4.8,P=0.017).The LPLNs of two patients in the non-IVG group were residual during LPND.In addition,no significant difference was found in terms of LPND,LPNM,operative time,conversion to laparotomy,preoperative complication,or hospital stay(P>0.05).CONCLUSION ICG-enhanced NIR fluorescence-guided imaging could be a feasible and convenient technique to guide LPND because it could bring specific advantages regarding the accuracy and completeness of surgery as well as safety.
文摘AIM To assess the clinical significance of prophylactic lateral pelvic lymph node dissection (LPLND) in stage Ⅳ low rectal cancer.METHODS We selected 71 consecutive stage Ⅳ low rectal cancer patients who underwent primary tumor resection,and enrolled 50 of these 71 patients without clinical LPLN metastasis.The patients had distant metastasis such as liver,lung,peritoneum,and paraaortic LN.Clinical LPLN metastasis was defined as LN with a maximum diameter of 10 mm or more on preoperative pelvic computed tomography scan.All patients underwent primary tumor resection,27 patients underwent total mesorectal excision(TME) with LPLND(LPLND group),and 23 patients underwent only TME(TME group).Bilateral LPLND was performed simultaneously with primary tumor resection in LPLND group.R0 resection of both primary and metastatic sites was achieved in 20 of 50 patients.We evaluated possible prognostic factors for 5-year overall survival (OS),and compared 5-year cumulative local recurrence between the LPLND and TME groups.RESULTS For OS,univariate analyses revealed no significant benefit in the LPLND compared with the TME group (28.7% vs 17.0%,P = 0.523); multivariate analysis revealed that R0 resection was an independent prognostic factor.Regarding cumulative local recurrence,the LPLND group showed no significant benefit compared with TME group (21.4% vs 14.8%,P = 0.833).CONCLUSION Prophylactic LPLND shows no oncological benefits in patients with Stage Ⅳ low rectal cancer without clinical LPLN metastasis.
文摘Objective This study aimed to compare and analyze the clinical efficacy and safety of late-course and simultaneous integrated dose-increasing intensity-modulated radiation therapy(IMRT) for cervical cancer complicated with pelvic lymph node metastasis. Methods Sixty patients with cervical cancer complicated with pelvic lymph node metastasis who were admitted to our hospital from January 2013 to January 2015 were enrolled. The patients were randomly divided into the late-course dose-increasing IMRT group and the simultaneous integrated dose-increasing IMRT group, with 30 cases included in each group, respectively. All patients were concurrently treated with cisplatin. After treatment, the clinical outcomes of the two groups were compared. Results The remission rate of symptoms in the simultaneous integrated dose-increasing IMRT group was significantly higher than that in the late-course dose-increasing IMRT group(P < 0.05). The follow-up results showed that the overall survival time, progression-free survival time, and distant metastasis time of patients in the simultaneous integrated dose-increasing IMRT group were significantly longer than those in the late-course dose-increasing IMRT group(P < 0.05). The recurrent rate of lymph nodes in the radiation field in the simultaneous integrated dose-increasing IMRT group was significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group. There was no significant difference in the incidence of cervical and vaginal recurrence and distant metastasis between the two groups(P > 0.05). The radiation doses of Dmax in the small intestine, D1 cc(the minimum dose to the 1 cc receiving the highest dose) in the bladder, and Dmax in the rectum in the simultaneous integrated dose-increasing IMRT group were significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group. There was no significant difference in intestinal D2 cc(the minimum dose to the 2 cc receiving the highest dose) between the two groups(P > 0.05). The incidence of bone marrow suppression in the simultaneous integrated dose-increasing IMRT group was significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group.Conclusion The application of simultaneous integrated dose-increasing IMRT in the treatment of cervical cancer patients complicated with pelvic lymph node metastasis can significantly control tumor progression, improve the long-term survival time, and postpone distant metastasis time with high safety.
文摘Background/Aims:Current guidelines suggest that the indications for pelvic lymph node(LN)dissection(PLND)during radical pros-tatectomy(RP)should rely on nomograms predicting their involvement.Positron emission tomography/computed tomography(PET/CT)with prostate-specific membrane antigen(PSMA)radioligand is gaining acceptance as routine diagnostic test before RP in patients with intermediate/high-risk prostate cancer(PC).In this study,we examined the effect of preoperative PET/CT on the accuracy of the nomograms.Materials and methods:Patients with intermediate/high risk PC showing no extraprostatic disease on PET/CT-PSMA underwent RP with PLND and were followed postoperatively for at least 6 months.Patients with detectable(>0.1 ng/mL)postoperative prostate-specific antigen levels underwent re-evaluation with PET/CT-PSMA.Results:A total of 70 patients underwent RP for intermediate(34 patients)or high-risk disease(36 patients).According to the Partin,MSKCC,and Briganti 2012 nomograms,positive LNs were expected in 7,13,and 12 patients,respectively.At PLND,1 positive LN was found in a single patient(p<0.05 compared with the expected number of patients from all nomograms).Postoperatively,10 pa-tients developed detectable prostate-specific antigen levels.One patient exhibited radioligand uptake that could indicate LN involve-ment.Considering these 2 patients as failures,the negative predictive value of PSMA-PET/CT for LN involvement was 97.1%.Conclusions:Preoperative PSMA-PET/CT with no extraprostatic uptake before RP in patients with intermediate to high-grade PC is highly accurate for ruling out LN involvement,superior to the routinely used nomograms.Its use induced stage migration,rendering pre-dictive nomograms irrelevant.
文摘Background：Pelvic lymph node metastasis （LNM） is an important prognostic factor in cervical cancer.Cervical squamous cell carcinoma accounts for approximately 75-80% of all cervical cancers.Analyses of the effects of the number of positive lymph nodes （LNs）,unilateral vcrsus bilateral pelvic LNM and a single group versus multiple groups of pelvic LNM on survival and recurrence of cervical squamous cell carcinoma are still lacking.The study aimed to analyze the effects of the number of positive pelvic LNs and a single group versus multiple groups of pelvic LNM on survival and recurrence.Methods：We performed a retrospective review of 296 patients diagnosed with Stage ⅠA-ⅡB cervical squamous cell carcinoma who received extensive/sub-extensive hysterectomy with pelvic lymphadenectomy/pelvic LN sampling at Peking University People＇s Hospital from November 2004 to July 2013.Ten clinicopathological variables were evaluated as risk factors for pelvic LNM：Age at diagnosis,gravidity,clinical stage,histological grade,tumor diameter,lymph-vascular space involvement （LVSI）,depth of cervical stromal invasion,uterine invasion,parametrial invasion,and neoadjuvant chemotherapy.Results：The incidence of pelvic LNM was 20.27% （60/296 cases）.Pelvic LNM （P =0.00） was significantly correlated with recurrence.Pelvic LNM （P =0.00）,the number of positive pelvic LNs （P =0.04） and a single group versus multiple groups of pelvic LNM （P =0.03）had a significant influence on survival.Multivariate analysis revealed that LVSI （P =0.00）,depth of cervical stromal invasion （P =0.00）and parametrial invasion （P =0.03） were independently associated with pelvic LNM.Conclusions：Patients with pelvic LNM had a higher recurrence rate and poor survival outcomes.Furthermore,more than 2 positive pelvic LNs and multiple groups of pelvic LNM appeared to identify patients with worse survival outcomes in node-positive ⅠA-ⅡB cervical squamous cell carcinoma.LVSI,parametrial invasion,and depth of cervical stromal invasion were identified as independent clinicopathological risk factors for pelvic LNM.
基金sponsored in part by the National Natural Science Foundation of China(Grant No.82220108007)Shenyang High Level Innovative Talents Support Program(Grant No.RC210138).
文摘Background The reproducibility of positron emission tomography(PET)radiomics features is affected by several factors,such as scanning equipment,drug metabolism time and reconstruction algorithm.We aimed to explore the role of 3D local binary pattern(LBP)-based texture in increasing the accuracy and reproducibility of PET radiomics for predicting pelvic lymph node metastasis(PLNM)in patients with cervical cancer.Methods We retrospectively analysed data from 177 patients with cervical squamous cell carcinoma.They un-derwent18 F-fluorodeoxyglucose(18 F-FDG)whole-body PET/computed tomography(PET/CT),followed by pelvic 18 F-FDG PET/magnetic resonance imaging(PET/MR).We selected reproducible and informative PET radiomics features using Lin’s concordance correlation coefficient,least absolute shrinkage and selection operator algorithm,and established 4 models,PET/CT,PET/CT-fusion,PET/MR and PET/MR-fusion,using the logistic regression al-gorithm.We performed receiver operating characteristic(ROC)curve analysis to evaluate the models in the training data set(65 patients who underwent radical hysterectomy and pelvic lymph node dissection)and test data set(112 patients who received concurrent chemoradiotherapy or no treatment).The DeLong test was used for pairwise comparison of the ROC curves among the models.Results The distribution of age,squamous cell carcinoma(SCC),International Federation of Gynaecology and Obstetrics stage and PLNM between the training and test data sets were different(P<0.05).The LBP-transformed radiomics features(50/379)had higher reproducibility than the original radiomics features(9/107).Accuracy of each model in predicting PLNM was as follows:training data set:PET/CT=PET/CT-fusion=PET/MR-fusion(0.848)and test data set:PET/CT=PET/CT-fusion(0.985)>PET/MR=PET/MR-fusion(0.954).There was no statistical difference between the ROC curve of PET/CT and PET/MR models in both data sets(P>0.05).Conclusions The LBP-transformed radiomics features based on PET images could increase the accuracy and reproducibility of PET radiomics in predicting pelvic lymph node metastasis in cervical cancer to allow the model to be generalised for clinical use across multiple centres.
文摘Background:Radical prostatectomy(RP)and radical cystectomy(RC)with concurrent pelvic lymph node dissection(PLND)are considered as the curative surgical treatment options for localized prostate cancer(PC)or muscle-invasive bladder cancer(BC).Regarding lymphatic leakage management after PLND,there is no standard of care,with different therapeutic approaches having been reported with varying success rates.Methods:Seventy patients underwent pelvic lymphadenectomy during robotic RP and RC with postoperative pelvic drainage volume more than 50 mL/day before the removal of drainage tube,were retrospectively evaluated in this study between August 2015 and June 2023.If the pelvic drainage volume on postoperative Day 2 was more than 50 mL/day,a drainage fluid creatinine was routinely tested to rule out urine leakage.We removed the drainage if the patient had no significant abdominal free fluid collection,no abdominal distension or pain,no fever,and no abdominal tenderness.After 1-day observation of the vital signs and abdominal symptoms,the patient was discharged and followed-up in clinic for 2 weeks after surgery.Results:Forty-one cases underwent the early drainage removal even if the pelvic drainage volume was more than 50mL/day.Among these forty-one cases,twenty-five drainage tubes were removed when drainage volume was more than 100 mL/day.All the forty-one cases with pelvic drainage volume greater than 50mL/day were successfully managed with the early drainage removal.No paracentesis or drainage placement was required.No readmission occured during the follow-up period.Conclusion:It is safe to manage the high-volume pelvic lymphatic leakage by early clamping of the drainage tube,ultrasonography assessment of no significant residual fluid in the abdominal and pelvic cavity,and then the early removal of the drainage tube.
文摘Background:Pelvic lymph node dissection(PLND)in radical cystectomy(RC)is of great significance,but the method and scope of PLND remain controversial.Based on the principle of indirect lymphadenography,we designed a method to localize the whole pelvic lymph nodes by intradermal injection of indocyanine green(ICG)through the lower limbs and perineum,and to evaluate the effectiveness of this method. Methods:In a single center,54 bladder cancer patients who underwent RC and PLND participated in a prospective clinical trial,which began on February 28,2022 and ended on December 30,2022.ICG solution was injected subcutaneously at the medial malleolus of both lower extremities and at both sides of the midline of the perineum.The fluorescent laparoscopy was used to trace,locate,and remove the targeted areas under the image fusion mode.The consistency of lymph node resection was determined by histopathological diagnosis.The impact of ICG guidance on the surgical time of PLND was compared with that of 11 bladder cancer patients who underwent RC and PLND without ICG injection,serving as the control group. Results:Perineal lower limb combined injection can provide comprehensive visualization of pelvic lymph nodes.This technique reduces PLND surgical time and increases the accuracy of PLND. Conclusion:Intracutaneous injection of ICG into the lower limbs and perineum can specifically mark pelvic lymph nodes.Intraoperative fluores-cence imaging can accurately identify,locate,and resect lymph nodes in the pelvic region,reducing PLND surgical time and increasing the accuracy of PLND.
文摘Background:The National Comprehensive Cancer Network(NCCN)guidelines recommend pelvic lymph node dissection(PLND)in NCCN high-and intermediate-risk prostate cancer patients.We tested for PLND nonadherence(no-PLND)rates within the Surveillance Epidemiology and End Results(2010-2015).Materials and methods:We identified all radical prostatectomy patients who fulfilled the NCCN PLND guideline criteria(n=23,495).Nonadherence rates to PLND were tabulated and further stratified according to NCCN risk subgroups,race/ethnicity,geographic distribution,and year of diagnosis.Results:Overall,the no-PLND rate was 26%;it was 41%,25%,and 11%in the NCCN intermediate favorable,intermediate unfavorable,and high-risk prostate cancer patients,respectively(p<0.001).Overtime,the no-PLND rates declined in the overall cohort and within each NCCN risk subgroup.Georgia exhibited the highest no-PLND rate(49%),whereas New Jersey exhibited the lowest(15%).Finally,no-PLND race/ethnicity differences were recorded only in the NCCN intermediate unfavorable subgroup,where Asians exhibited the lowest no-PLND rate(20%)versus African Americans(27%)versus Whites(26%)versus Hispanic-Latinos(25%).Conclusions:The lowest no-PLND rates were recorded in the NCCN high-risk patients followed by NCCN intermediate unfavorable and favorable risk in that order.Our findings suggest that unexpectedly elevated differences in no-PLND rates warrant further examination.In all the NCCN risk subgroups,the no-PLND rates decreased over time.
文摘Extended pelvic lymphadenectomy(EPL) with total mesorectal excision(TME) has been reported to provide oncological benefit in lower rectal cancer in Japan.In Western countries EPL is not widely accepted because of frequent morbidity but instead preoperative chemoradiation(CRT) followed by TME has been established as a standard treatment for decreasing local recurrence.Recently,several studies have focused on the comparison between these two distinct therapeutic approaches in Western countries and Japan.A study comparing Dutch trial data and Japanese data revealed that EPL and RT are almost equivalent in decreasing local recurrence in lower rectal cancer as compared with TME alone.Considering that almost 45 survival can be achieved by EPL even in the presence of metastatic lateral lymph nodes(LLNs),EPL performed by experienced surgeons definitely contributes to decrease local recurrence.On the other hand,a randomized controlled trial in Japan that compared EPL with conventional TME following preoperative RT revealed that EPL is associated with a higher frequency of sexual and urinary dysfunction without oncological benefits in the presence of preoperative RT.On this point,preoperative CRT followed by conventional TME without EPL would be a better therapeutic approach in patients without evident metastatic LLNs.For future treatment,it would be desirable to have a narrower indication for EPL using full advantage of recent improvement in image diagnosis.Although objective comparison of these two principles between Japan and the West is difficult due to differences in patient groups,further studies would lead to the next great step towards future improvement in treating lower rectal cancer.
文摘Objective: To assess the value of sentinel lymph node (SLN) localization by lymphoscintigraphy and gamma probe detection in early cervical cancer. Methods: A total of 27 patients with operable invasive early cervical cancer and clinically proved negative pelvic lymph nodes were included in this study. The 99Tcm-dextran of 74 MBq (2 mCi) was injected around the cervix at 2 and 10. Lymphoscintigraphy and gamma probe detection were used to find the SLN. Results: The SLN was identified in 27 patients. The sensitivity and specificity of the SLN detection to predict the metastasis of the pelvic lymph node were 100% and 100% respectively. Conclusion: Identification of the SLN using radionuclide is feasible and possible in women with early cervical cancer.
文摘BACKGROUND Lateral pelvic lymph node(LLN)metastasis(LLNM)occur in up to 28%of patients with low rectal tumours.While prophylactic lateral pelvic lymph node dissection(LLND)has been abandoned by most western institutions in the era of neoadjuvant chemoradiation therapy(CRT),the role of selective LLND in patients with enlarged LLN on pre-CRT imaging remains unclear.Some studies have shown improved survival and recurrence outcomes when LLNs show"response"to CRT.However,no management algorithm exists to differentiate treatment for"responders"vs"non-responders".AIM To determine if selective LLND in patients with enlarged LLNs results in improved survival and recurrence outcomes.METHODS A systemic search of Pub Med and Embase databases for studies reporting on patients with synchronous radiologically suspicious LLNM(s-LLNM)in rectal cancer receiving preoperative-CRT was performed.RESULTS Fifteen retrospective,single-centre studies were included.793 patients with sLLNM were evaluated:456 underwent TME while 337 underwent TME with7,LLND post-CRT.In the TME group,local recurrence(LR)rates range from 12.5%to 36%.Five-year disease free survival(DFS)was 42%to 75%.In the TME with LLND group,LR rates were 0%to 6%.Five years DFS was 41.2%to 100%.Radiological response was seen in 58%.Pathologically positive LLN was found in up to 94%of non-responders vs 0%to 20%in responders.Young age,low tumour location and radiological non-response were associated with final positive LLNM and lowered DFS.CONCLUSION LLND is associated with local control in patients with s-LLNM.It can be performed in radiological non-responders given a large majority represent true LLNM.Its role in radiological responders should be considered in selected high risk patients.
基金supported by the Graduate Research-Innovation Project in Jiangsu Province(No.SJCX21_1644)the Academic Science and Technology Innovation Fund for College Students(No.202011117056Y)+3 种基金the Social Development-Health Care Project of Yangzhou,Jiangsu Province(No.YZ2021075)the High-level Talent“Six One Projects”Top Talent Scientific Research Project of Jiangsu Province(No.LGY2019034)the Graduate Research-Innovation Project in Jiangsu Province(SJCX22_1816)the Social Development Project of the Key R&D Plan of Jiangsu Provincial Department of Science and Technology(BE2022773).
文摘The clearance of lesions during surgery for colorectal cancer encompasses the removal of both the primary tumour and its concomitant lymphatic drainage.Huge strides have been made in identifying the precise location of not only the primary tumour,but also the lymph nodes(LNs),owing to the use of intraoperative navigation techniques.Among these techniques,indocyanine green-enhanced fluorescence imaging(ICG-FI)has revolutionized colorectal oncologic surgery by providing clear visualization during lymphangiography.ICG-FI has emerged as a powerful tool for sentinel lymph node procedures that allows for local excision instead of radical D3 lymphadenectomy.It also makes it possible to identify potential metastatic lateral pelvic lymph nodes,which enables simultaneous lymphadenectomy of the pelvic side-wall during the resection of middle-lower rectal cancer.This review provides an update on the current use of and research on ICG-FI-guided LNs mapping for colorectal malignancies,and also discusses its drawbacks and future prospects.
基金National Natural Science Foundation of China(Nos.92159105 and 81872113)Guangdong Province(No.2020A0505100028)
文摘To the Editor:Cervical cancer(CC)is the second leading cause of cancer death in women,representing a major global health challenge.[1]Cervical squamous cell carcinoma(CSCC)accounts for 70%of CC cases,and pelvic lymph node metastasis is a critical cause of CC-related death.[2]Thus,understanding the underlying mechanisms of the tumor spread through lymphatic vessels becomes imperative.[3]RNA helicases are involved in almost all aspects of RNA metabolism.[4]DEAD-box helicase 24(DDX24),one of the least explored DEAD-box RNA helicases,was upregulated in several cancer types.[5]However,the role of DDX24 in CSCC progression and metastasis remains elusive.Here,we investigated the essential role of DDX24 in mediating cancer cell EMT and lymphangiogenesis in the context of CSCC.Our study provides a potential therapeutic target for CSCC lymphatic metastasis.
文摘目的探讨早期宫颈癌、子宫内膜癌、卵巢癌术中保留腹股沟深淋巴结是否可以减轻术后下肢淋巴水肿。方法采用前瞻性随机对照研究设计,纳入2022年7月~2023年7月早期宫颈癌、子宫内膜癌、卵巢癌100例,随机分为保留组(保留腹股沟深淋巴结,n=50)和切除组(切除腹股沟深淋巴结,n=50)。均由同一手术团队行根治性手术。术后1、2、6、12个月评估下肢淋巴水肿情况,采用妇科恶性肿瘤淋巴水肿问卷(Gynecologic Cancer Lymphedema Questionnaire,GCLQ)和下肢周径测量进行诊断。结果保留组下肢淋巴水肿发生率6%(3/50),显著低于切除组的20%(10/50)(χ^(2)=4.332,P=0.037),且发生时间较晚[(5.3±3.1)月vs.(2.3±1.6)月,t=2.394,P=0.036],2组下肢淋巴水肿分期和部位差异无显著性(P>0.05)。结论在早期宫颈癌、子宫内膜癌及卵巢癌手术中保留腹股沟深淋巴结可显著降低术后下肢淋巴水肿的发生率。
