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
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
BACKGROUND Pelvic recurrence after rectal cancer surgery is still a significant problem despite the introduction of total mesorectal excision and chemoradiation treatment(CRT),and one of the most common areas of recur...BACKGROUND Pelvic recurrence after rectal cancer surgery is still a significant problem despite the introduction of total mesorectal excision and chemoradiation treatment(CRT),and one of the most common areas of recurrence is in the lateral pelvic lymph nodes.Hence,there is a possible role for lateral pelvic lymph node dissection(LPND)in rectal cancer.AIM To evaluate the short-term outcomes of patients who underwent minimally invasive LPND during rectal cancer surgery.Secondary outcomes were to evaluate for any predictive factors to determine lymph node metastases based on pre-operative scans.METHODS From October 2016 to November 2019,22 patients with stage II or III rectal cancer underwent minimally invasive rectal cancer surgery and LPND.These patients were all discussed at a multidisciplinary tumor board meeting and most of them received neoadjuvant chemoradiation prior to surgery.All patients had radiologically positive lateral pelvic lymph nodes on the initial staging scans,defined as lymph nodes larger than 7 mm in long axis measurement,or abnormal radiological morphology.LPND was only performed on the involved side.RESULTS Majority of the patients were male(18/22,81.8%),with a median age of 65 years(44-81).Eighteen patients completed neoadjuvant CRT pre-operatively.18 patients(81.8%)had unilateral LPND,with the others receiving bilateral surgery.The median number of lateral pelvic lymph nodes harvested was 10(3-22)per pelvic side wall.8 patients(36.4%)had positive metastases identified in the lymph nodes harvested.The median pre-CRT size of these positive lymph nodes was 10 mm.Median length of stay was 7.5 d(3-76),and only 2 patients failed initial removal of their urinary catheter.Complication rates were low,with only 1 lymphocele and 1 anastomotic leak.There was only 1 mortality(4.5%).There have been no recurrences so far.CONCLUSION Chemoradiation is inadequate in completely eradicating lateral wall metastasis and there are still technical limitations in accurately diagnosing metastases in these areas.A 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
Objective:The aim of the study is to evaluate the effect of deferred androgen deprivation therapy on biochemical recurrence(BCR)and other survival parameters in node-positive prostate cancer patients after robot-assis...Objective:The aim of the study is to evaluate the effect of deferred androgen deprivation therapy on biochemical recurrence(BCR)and other survival parameters in node-positive prostate cancer patients after robot-assisted radical prostatectomy with bilateral extended pelvic lymph node dissection(RARP+EPLND).Materials and methods:Of the 453 consecutive RARP procedures performed from 2011 to 2018,100 patients with no prior use of androgen deprivation therapy were found to be lymph node(LN)positive and were observed,with initiation of salvage treatment at the time of BCR only.Patients were divided into 1 or 2 LNs(67)-and more than 2 LNs(33)-positive groups to assess survival outcomes.Results:At a median follow-up of 21 months(1-70 months),the LN group(p<0.000),preoperative prostate-specific antigen(PSA,p=0.013),tumor volume(TV,p=0.031),and LND(p=0.004)were significantly associated with BCR.In multivariate analysis,only the LN group(p=0.035)and PSA level(p=0.026)were statistically significant.The estimated BCR-free survival rates in the 1/2 LN group were 37.6%(27%-52.2%),26.5%(16.8%-41.7%),and 19.9%(9.6%-41.0%)at 1,3,and 5 years,respectively,with a hazard of developing BCR of 0.462(0.225-0.948)compared with the more than 2 LN-positive group.Estimated 5-year overall survival,cancer-specific,metastasis-free,and local recurrence-free survival rates were 88.4%(73.1%-100%),89.5%(74%-100%),65.1%(46.0%-92.1%),and 94.8%(87.2%-100.0%),respectively,for which none of the factors were significant.Based on cutoff values for PSA,TV,and LND of 30 ng/mL,30%,and 10%,respectively,the 1/2 LN group was substratified,wherein the median BCR-free survival for the low-and intermediate-risk groups was 40 and 12 months,respectively.Conclusions:Nearly one fourth and one fifth of 1/2 node-positive patients were BCR-free at 3 and 5 years after RARP+EPLND.Further substratification using PSA,TV,and LN density may help in providing individualized care regarding the initiation of adjuvant therapy.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
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 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
目的:探讨联合腹腔镜下广泛子宫切除术及盆腔淋巴结清扫术对早期宫颈癌患者手术时长及术后康复的影响。方法:选取2014年2月至2016年8月驻马店市中心医院74例早期宫颈癌患者,通过随机数字表法分为对照组与研究组(n=37)。研究组联合采用...目的:探讨联合腹腔镜下广泛子宫切除术及盆腔淋巴结清扫术对早期宫颈癌患者手术时长及术后康复的影响。方法:选取2014年2月至2016年8月驻马店市中心医院74例早期宫颈癌患者,通过随机数字表法分为对照组与研究组(n=37)。研究组联合采用腹腔镜下广泛子宫切除术及盆腔淋巴结清扫术,对照组联合采用开腹广泛子宫切除术及盆腔淋巴结清扫术,术后随访3~6个月。统计对比两组手术情况(手术时长、术中失血量、淋巴结清扫数目)、术后康复情况(肛门排气时间、肛门排便时间、拔管时间、抗生素应用时间、住院时间)、入院时及术后3,6个月生活质量评分(Functional Assessment of Cancer Therapy-General,FACT-G)、并发症发生率。结果:研究组手术时长较对照组长,术中失血量较对照组少,淋巴结清扫数目较对照组多(P<0.05);研究组肛门排气时间、肛门排便时间、拔管时间、抗生素应用时间、住院时间较对照组少(P<0.05);术前两组FACT-G分值比较差异无统计学意义(P>0.05),术后3,6个月研究组FACT-G分值较对照组高(P<0.05);两组并发症发生率比较,研究组5.41%(2/37)较对照组24.32%(9/37)低(P<0.05)。结论:联合采用腹腔镜下广泛子宫切除术及盆腔淋巴结清扫术治疗早期宫颈癌效果显著,可有效减少手术创伤,促使术后机体功能康复,改善患者生活质量,且并发症较少,具有较高安全性。展开更多
目的比较中低位直肠癌患者在腹腔镜与开放全直肠系膜切除术(TME)基础上行侧方淋巴结清扫的围手术期临床结果,以探讨腹腔镜盆腔淋巴结清扫术的可行性及安全性。方法对浙江省肿瘤医院同期16例腹腔镜及55例开放侧方淋巴结清扫术患者临床资...目的比较中低位直肠癌患者在腹腔镜与开放全直肠系膜切除术(TME)基础上行侧方淋巴结清扫的围手术期临床结果,以探讨腹腔镜盆腔淋巴结清扫术的可行性及安全性。方法对浙江省肿瘤医院同期16例腹腔镜及55例开放侧方淋巴结清扫术患者临床资料进行回顾性分析,比较了两组间围手术期手术时间、术中出血量、侧方淋巴结清扫数目、术后并发症及术后住院时间。结果腹腔镜组与开放组患者基础临床特征相似。两组患者均无围手术期死亡。腹腔镜组患者无中转开腹手术。腹腔镜组比开放组手术时间显著延长(218.6±71.6 min vs.181.3±57.9 min,P=0.035)、术中出血量显著减少(190.6±80.1 ml vs.344.9±295.2 ml,P=0.044)。腹腔镜组与开放组清扫的侧方淋巴结数目(9.8±6.1枚vs.11.0±9.7枚,P=0.642)、侧方淋巴结转移阳性率(25.0%vs.34.5%,P=0.556)、术后并发症发生率(25.0%vs.20.0%,P=0.666)、术后住院时间(10.9±3.5天vs.13.8±7.1天,P=0.125)差异均无统计学意义。侧方淋巴结转移与肿瘤低分化(P=0.001)、阳性脉管瘤栓(P=0.011)和神经侵犯(P=0.002)相关,但与术前是否行放化疗(P=0.479)及肿瘤大小(P=0.907)无关。结论腹腔镜直肠癌全系膜切除术基础上的侧方淋巴结清扫是安全可行的,并能达到和传统开放手术同样的围手术期临床效果。展开更多
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BACKGROUND Pelvic recurrence after rectal cancer surgery is still a significant problem despite the introduction of total mesorectal excision and chemoradiation treatment(CRT),and one of the most common areas of recurrence is in the lateral pelvic lymph nodes.Hence,there is a possible role for lateral pelvic lymph node dissection(LPND)in rectal cancer.AIM To evaluate the short-term outcomes of patients who underwent minimally invasive LPND during rectal cancer surgery.Secondary outcomes were to evaluate for any predictive factors to determine lymph node metastases based on pre-operative scans.METHODS From October 2016 to November 2019,22 patients with stage II or III rectal cancer underwent minimally invasive rectal cancer surgery and LPND.These patients were all discussed at a multidisciplinary tumor board meeting and most of them received neoadjuvant chemoradiation prior to surgery.All patients had radiologically positive lateral pelvic lymph nodes on the initial staging scans,defined as lymph nodes larger than 7 mm in long axis measurement,or abnormal radiological morphology.LPND was only performed on the involved side.RESULTS Majority of the patients were male(18/22,81.8%),with a median age of 65 years(44-81).Eighteen patients completed neoadjuvant CRT pre-operatively.18 patients(81.8%)had unilateral LPND,with the others receiving bilateral surgery.The median number of lateral pelvic lymph nodes harvested was 10(3-22)per pelvic side wall.8 patients(36.4%)had positive metastases identified in the lymph nodes harvested.The median pre-CRT size of these positive lymph nodes was 10 mm.Median length of stay was 7.5 d(3-76),and only 2 patients failed initial removal of their urinary catheter.Complication rates were low,with only 1 lymphocele and 1 anastomotic leak.There was only 1 mortality(4.5%).There have been no recurrences so far.CONCLUSION Chemoradiation is inadequate in completely eradicating lateral wall metastasis and there are still technical limitations in accurately diagnosing metastases in these areas.A
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Objective:The aim of the study is to evaluate the effect of deferred androgen deprivation therapy on biochemical recurrence(BCR)and other survival parameters in node-positive prostate cancer patients after robot-assisted radical prostatectomy with bilateral extended pelvic lymph node dissection(RARP+EPLND).Materials and methods:Of the 453 consecutive RARP procedures performed from 2011 to 2018,100 patients with no prior use of androgen deprivation therapy were found to be lymph node(LN)positive and were observed,with initiation of salvage treatment at the time of BCR only.Patients were divided into 1 or 2 LNs(67)-and more than 2 LNs(33)-positive groups to assess survival outcomes.Results:At a median follow-up of 21 months(1-70 months),the LN group(p<0.000),preoperative prostate-specific antigen(PSA,p=0.013),tumor volume(TV,p=0.031),and LND(p=0.004)were significantly associated with BCR.In multivariate analysis,only the LN group(p=0.035)and PSA level(p=0.026)were statistically significant.The estimated BCR-free survival rates in the 1/2 LN group were 37.6%(27%-52.2%),26.5%(16.8%-41.7%),and 19.9%(9.6%-41.0%)at 1,3,and 5 years,respectively,with a hazard of developing BCR of 0.462(0.225-0.948)compared with the more than 2 LN-positive group.Estimated 5-year overall survival,cancer-specific,metastasis-free,and local recurrence-free survival rates were 88.4%(73.1%-100%),89.5%(74%-100%),65.1%(46.0%-92.1%),and 94.8%(87.2%-100.0%),respectively,for which none of the factors were significant.Based on cutoff values for PSA,TV,and LND of 30 ng/mL,30%,and 10%,respectively,the 1/2 LN group was substratified,wherein the median BCR-free survival for the low-and intermediate-risk groups was 40 and 12 months,respectively.Conclusions:Nearly one fourth and one fifth of 1/2 node-positive patients were BCR-free at 3 and 5 years after RARP+EPLND.Further substratification using PSA,TV,and LN density may help in providing individualized care regarding the initiation of adjuvant therapy.
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.
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.
文摘目的:探讨联合腹腔镜下广泛子宫切除术及盆腔淋巴结清扫术对早期宫颈癌患者手术时长及术后康复的影响。方法:选取2014年2月至2016年8月驻马店市中心医院74例早期宫颈癌患者,通过随机数字表法分为对照组与研究组(n=37)。研究组联合采用腹腔镜下广泛子宫切除术及盆腔淋巴结清扫术,对照组联合采用开腹广泛子宫切除术及盆腔淋巴结清扫术,术后随访3~6个月。统计对比两组手术情况(手术时长、术中失血量、淋巴结清扫数目)、术后康复情况(肛门排气时间、肛门排便时间、拔管时间、抗生素应用时间、住院时间)、入院时及术后3,6个月生活质量评分(Functional Assessment of Cancer Therapy-General,FACT-G)、并发症发生率。结果:研究组手术时长较对照组长,术中失血量较对照组少,淋巴结清扫数目较对照组多(P<0.05);研究组肛门排气时间、肛门排便时间、拔管时间、抗生素应用时间、住院时间较对照组少(P<0.05);术前两组FACT-G分值比较差异无统计学意义(P>0.05),术后3,6个月研究组FACT-G分值较对照组高(P<0.05);两组并发症发生率比较,研究组5.41%(2/37)较对照组24.32%(9/37)低(P<0.05)。结论:联合采用腹腔镜下广泛子宫切除术及盆腔淋巴结清扫术治疗早期宫颈癌效果显著,可有效减少手术创伤,促使术后机体功能康复,改善患者生活质量,且并发症较少,具有较高安全性。
文摘目的比较中低位直肠癌患者在腹腔镜与开放全直肠系膜切除术(TME)基础上行侧方淋巴结清扫的围手术期临床结果,以探讨腹腔镜盆腔淋巴结清扫术的可行性及安全性。方法对浙江省肿瘤医院同期16例腹腔镜及55例开放侧方淋巴结清扫术患者临床资料进行回顾性分析,比较了两组间围手术期手术时间、术中出血量、侧方淋巴结清扫数目、术后并发症及术后住院时间。结果腹腔镜组与开放组患者基础临床特征相似。两组患者均无围手术期死亡。腹腔镜组患者无中转开腹手术。腹腔镜组比开放组手术时间显著延长(218.6±71.6 min vs.181.3±57.9 min,P=0.035)、术中出血量显著减少(190.6±80.1 ml vs.344.9±295.2 ml,P=0.044)。腹腔镜组与开放组清扫的侧方淋巴结数目(9.8±6.1枚vs.11.0±9.7枚,P=0.642)、侧方淋巴结转移阳性率(25.0%vs.34.5%,P=0.556)、术后并发症发生率(25.0%vs.20.0%,P=0.666)、术后住院时间(10.9±3.5天vs.13.8±7.1天,P=0.125)差异均无统计学意义。侧方淋巴结转移与肿瘤低分化(P=0.001)、阳性脉管瘤栓(P=0.011)和神经侵犯(P=0.002)相关,但与术前是否行放化疗(P=0.479)及肿瘤大小(P=0.907)无关。结论腹腔镜直肠癌全系膜切除术基础上的侧方淋巴结清扫是安全可行的,并能达到和传统开放手术同样的围手术期临床效果。
