Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Retroperitoneal lymph node dissection”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 811 records · Page 45Linked to original sources
PubMed2001

Iatrogenic ejaculation disorders and their prevention.

Ejaculation is mediated by sympathetic fibers originating from the D10-L2 medullar center. These nerves rise from the lumbar ganglia of the paravertebral sympathetic trunk and travel posteriorly to the vena cava and then to the interaortocaval space, on the right side, and laterally to the aorta, on the left side. They are the principal constituents of the superior hypogastric plexus. Many surgical operations can cause an ejaculation disorder, but the most important is retroperitoneal lymphadenectomy (RL) for testis cancer, because it involves young patients and it has been the subject of important researches in order to perform lymph node dissection without ejaculation loss (unilateral lymphadenectomy and nerve sparing lymphadenectomy). Our experience concerns 41 patients who underwent RL for testis cancer from 1983 to 1998. Survival rate was 95.2% (mean follow up 64 months). RL was performed bilaterally in 14 patients. Two of them died of metastases within 2 years after the operation. Ejaculation was maintained in only 4 of the 12 surviving patients (33%). All the 17 patients (100%) underwent right monolateral RL and 7 of the 10 (70%) underwent left monolateral RL preserved ejaculation. The anatomosurgical concepts of the RL sparing the ejaculation can be adopted in other retroperitoneal surgical operations that can produce ejaculation disorders, such as wide lymphadenectomy for renal cell carcinoma or tumors of the upper urinary tract, exeresis of pre- aortic tumors, exeresis or disjunction of horseshoe kidney and aorto-iliac revascularization. Surgical therapy of benign prostatic hyperplasia (BPH) (open surgery or transurethral prostatic resection) is associated with retrograde ejaculation in nearly 100% of cases. The mechanism of the dysfunction is clear, if following the procedure the bladder neck remains opened. Loss of ejaculation is reported in variable percentage after the newer endoscopic techniques for the treatment of BPH. Transurethral needle ablation (TUNA) seems to have the lower risk of retrograde ejaculation. Retrograde ejaculation can also be related to a traumatic injury of the posterior urethra, because of the trauma itself or the therapy. Finally, the ejaculation disorder can be produced by several drugs that block, as a main or secondary effect, the alpha-adrenoreceptors or act at the central level. This side effect has to be kept in mind when these drugs are used in young or sexually active patients.

Ejaculation↗
PubMed1994

[Delay of the formation of retroperitoneal fibrosis after lymphadenectomy. An experimental study].

The goal of our study was to evaluate peritoneal and retroperitoneal healing and therefore to assess the optimal date for surgery after laparoscopic lymphadenectomy. A para-aortic lymphadenectomy was carried out in 5 groups of 5 New Zealand female rabbits. The perivascular cicatricial tissue was dissected after specific delay for each group (48 hours, 1 week, 2 weeks, 4 weeks, and 6 weeks). Peritoneal reconstruction was observed in 80% of the "48 h" group, and in 100% in the other groups (from 1 to 6 weeks). Vascular injury complicated dissection in 40% for the "1 week" group, in 80% for the "2 weeks" group, and in 20% for the "6 weeks" group. No vascular complication was observed in the "48 h" and "4 weeks" groups. The results of "1 week" and "2 weeks" were combined. The results of the "4 weeks" group were compared, with the Fisher test, to the results of a "1 week" and "2 weeks" combined group as well as to the results of the "six weeks" group. Four weeks seem to be the optimal date for a possible surgical excision after a laparoscopic lymphadenectomy.

Adipose Tissue↗
PubMedDate not supplied

Retroperitoneal leiomyosarcoma mimicking acute appendicitis: laparoscopic management.

BACKGROUND: Retroperitoneal leiomyosarcomas (RLMS) are a challenging clinical entity. The vast majority of patients are operated on when tumors are advanced. We report herein a case of RLMS, mimicking acute appendiceal disease and treated successfully via laparoscopy. METHODS: A 37-year-old woman, para 1, was admitted to our department for right lower quadrant abdominal pain, fever, and leukocytosis. She had no changes in gastrointestinal and urologic function. A physical examination revealed the presence of abdominal guarding, rebound, and a tender mass in the right lower quadrant. The abdominal ultrasound showed an inhomogeneous ovoid mass (6 cm in diameter) located below the cecum, with no definite margins, and consistent with an appendiceal abscess. The patient was referred for laparoscopy. The procedure was performed with the aid of 3 ports: a 12-mm trocar in the umbilicus (open technique), a 10-mm trocar in the left iliac fossa, and a 5-mm one in the supra-pubic space. On inspection of the abdominal cavity, a retroperitoneal 6-cm mass was immediately found below the cecum and the appendix. Neither intraperitoneal seeding nor suspected lymph nodes were present. After dissection of the parietal peritoneum, the mass appeared to be encapsulated and well demarcated from all surrounding structures. It was eventually dissected and removed via a plastic bag. A standard appendectomy was also performed. The postoperative course was uneventful, and the patient was discharged on the 3rd day. The histology analysis of the resected specimen showed a totally excised G2 leiomyosarcoma. The appendix had no signs of inflammation. Postoperatively, the patient underwent a total-body CT-scan, which had no signs of residual or distant disease. No adjuvant therapy was necessary. At an 18-month follow-up, the patient was doing well and was disease free. CONCLUSION: Surgery represents the main therapeutic option for resectable RLMS. Laparoscopy is a useful diagnostic tool that allows safe resection of incidentally discovered, small and well encapsulated RLMS.

Acute Disease↗
PubMed2005

Combined PET/CT for detecting recurrent ovarian cancer limited to retroperitoneal lymph nodes.

OBJECTIVE: To evaluate the utility of combined positron emission tomography/computed tomography (PET/CT) for detecting recurrent epithelial ovarian cancer limited to retroperitoneal adenopathy. METHODS: Fourteen patients (median age = 53 years) with rising serum CA125 levels, and negative or equivocal conventional CT imaging > or = 6 months after primary therapy were retrospectively identified as having recurrent disease limited to retroperitoneal lymph nodes by combined PET/CT and underwent surgical reassessment of targeted nodal basins. Fisher's Exact Test was used to measure the ability of PET/CT to predict isolated retroperitoneal nodal disease. RESULTS: The median increase in serum CA125 from baseline nadir was 14 U/ml (range = 2-76 U/ml). There were 29 target nodes in 15 nodal basins identified with increased metabolic uptake on combined PET/CT. Eleven patients (78.6%) had recurrent ovarian cancer in retroperitoneal lymph nodes targeted by PET/CT. Of 143 nodes retrieved, 59 contained recurrent ovarian cancer (median nodal diameter = 2.5 cm, range = 0.8-5.2 cm). For all target nodal basins, the sensitivity, specificity, positive and negative predictive values, and accuracy for recurrent ovarian cancer in dissected lymph nodes were: 40.7% (24/59), 94.0% (79/84), 82.8% (24/29), 69.3% (79/114), and 72.0% (103/143) (P < 0.001). PET/CT failed to identify microscopic disease in 59.3% of pathologically positive nodes. CONCLUSION: Combined PET/CT demonstrates high positive predictive value in identifying recurrent ovarian cancer in retroperitoneal lymph nodes when conventional CT findings are negative or equivocal. The high incidence of occult disease within the target nodal basins suggests that regional lymphadenectomy may be necessary for complete secondary cytoreduction of recurrent disease.

Adult↗
PubMed2004

[Alveolar rhabdomyosarcoma originating in spermatic cord: a case report].

A 19-year-old man visited our hospital complaining of swelling of the left inguinal region. A thumb head-sized tumor was palpated through the skin on the left spermatic cord. Tumor resection was performed because it was dissected easily apart from the left spermatic cord. Pathological examination revealed alveolar rhabdomyosarcoma with positive surgical margin. Computed tomographic scanning revealed no retroperitoneal lymph node swelling, and there were no clinical findings of distant metastasis (clinical stage I). Radical inguinal orchiectomy with combined chemotherapy using vincristine, dactinomycin, and ifosfamide (VAI) was performed. He has been alive without any recurrence for 8 years and 8 months after the surgery.

Adult↗
PubMed1983

Thoracoabdominal retroperitoneal lymphadenectomy for nonseminomatous testicular cancer.

Retroperitoneal lymphadenectomy remains a mainstay of the management of patients with nonseminomatous testicular cancer. The operation provides accurate information regarding stage and prognosis, which current preoperative staging studies cannot duplicate. The therapeutic value of lymphadenectomy has been demonstrated more clearly for testicular tumors than for any other cancer. Properly performed, the operation results in complete removal of all node-bearing tissue at significant risk of harboring metastases. Yet the morbidity and mortality are low in these young, generally vigorous patients. The only long-term sequela is loss of ejaculation. Efforts are currently underway to determine limits to the operation that will preserve ejaculation while maintaining the efficacy of the procedure.

Castration↗
PubMed2004

Nerve-sparing retroperitoneal lymphadenectomy using hydro-jet dissection: initial experience.

BACKGROUND AND PURPOSE: Nerve-sparing retroperitoneal lymphadenectomy (RPL) is performed in a significant number of patients to preserve ejaculation after treatment for testicular cancer. Identification and preservation of the sympathetic nerves may be challenging. Hydro-Jet technology has been utilized for various surgical applications. A small high-pressure stream of water is used to delineate surgical planes, with preservation of vascular and neural structures. We have examined the utility of this technology for RPL in a porcine model and in human subjects. MATERIALS AND METHOD: A Helix Hydro-Jet device (Erbe, USA) was used for all procedures. A high-pressure water-jet stream is directed through a small nozzle with a 120-microm inner radius for soft-tissue dissection. The upper pressure limit (range 0-2175 psi) is set using a digital monitor. The jet is initiated using a foot pedal, and the actual pressure is monitored. A pressure of 360 to 400 psi was used for experimental studies, which was decreased to 255 to 300 psi for human use. Three pigs underwent RPL using this technique. Subsequently, RPL was performed in five men with testicular cancer, being primary in two and postchemotherapy in three. The primary diagnosis was seminoma in one and non-seminomatous cancer in four. The patient with seminoma had a residual mass after chemotherapy. RESULTS: The procedures were completed successfully in all subjects. There were no intraoperative or postoperative complications. Hydro-Jet dissection permitted tissue selectivity, with preservation of vascular structures and sympathetic nerves. The soft tissue and lymphatics were removed with the high-pressure water stream assisted by blunt dissection. The nerve fibers were grossly resistant to the pressure used and were isolated individually. Dissection around the great vessels appeared to be safe, and no injury was observed with direct application of the jet. Lumbar arteries and veins and accessory vessels could be isolated safely. The estimated blood loss was minimal in animals and 300 to 800 mL in humans. CONCLUSIONS: Hydro-Jet dissection demonstrated tissue selectivity using a pressure range of 255 to 300 psi in humans. The vascular structures and sympathetic nerves were preserved. Our initial experience with this device for nerve-sparing RPL is encouraging.

Adult↗
PubMed2003

[Laparoscopic retroperitoneal lymphnode dissection for testicular cancer: Nagoya experience].

Three patients with stage I disease and 3 patients with stage III disease were treated with laparoscopic retroperitoneal lymphnode dissection. The patient was placed in a semilateral position and 5 trocars were introduced through the lateral abdominal wall. After incising the peritoneum along the Toldt line, the colon was reflected medially and the retroperitoneal structures such as the ureter, aorta, inferior vena cava and both renal arteries and veins were exposed. For right-side disease the paracaval and interaortocaval lymphnodes were dissected, and for left-side disease, the interaortocaval and paraaortic lymphnodes were dissected. The procedure was completed successfully on all 6 patients. The average operative time was 3.4 hours for 3 patients with stage I disease and 4.4 hours for 3 patients with stage III disease treated with prior chemotherapy. All patients started to walk and resumed oral intake from the first post-operative day and the average duration to full convalescence was 21 days. Anteriograde ejaculation and erection were preserved in all six patients. Laparoscopic retroperitoneal lymphnode dissection will be a useful technique for management of testicular cancer.

Adult↗
PubMed1992

Retroperitoneal surgery in patients with nonseminomatous testicular cancer and minimal residual tumor.

In the period 1980-1991, 78 patients with advanced nonseminomatous testicular cancer underwent retroperitoneal lymphadenectomy for post-chemotherapy residual masses less than 2 cm. To decrease the frequency of "dry ejaculation" in these patients with no or limited residual disease, the extent of dissection was reduced during the period, with bilateral dissections (49 cases, 1980-1986) being initially replaced by unilateral procedures (19 cases, 1983-1990) and subsequently by nerve-sparing techniques (10 cases, 1990-1991). As expected, a higher total number of lymph nodes was found in the retroperitoneal specimens after bilateral (44 (13-100)) than after unilateral (21 (7-35)) and nerve-sparing (18 (7-60)) procedures. The number of lymph nodes with pathological changes was low, with 3 (1-16) after bilateral, 2 (1-9) after unilateral, and 2 (1-4) after nerve-sparing operations. Histological examination revealed only necrosis/fibrosis in 65% of the patients, elements of mature teratoma in 28%, and remnants of viable malignant tumor in 6%. There were no major postoperative complications. "Dry ejaculation" was reported by 84% of the patients with bilateral operations, but was generally avoided after the unilateral (16%) and nerve-sparing (nil) procedures. After a mean follow-up of 83 (5-138) months, 6 patients have developed a recurrence, only one of them primarily in the retroperitoneal space. It is concluded that in patients with minimal residual retroperitoneal tumor, postchemotherapy lymphadenectomy using a unilateral or nerve-sparing technique seems to offer an effective therapeutic alternative with acceptable postoperative morbidity and preserved ejaculation.

Adolescent↗
PubMed1998

[Management of invasive carcinoma of bladder and abdominal aortic aneurysm (AAA); technique of radical total cystectomy and simultaneous AAA repair].

BACKGROUND: There is no consensus on the optimal surgical treatment for patients with concomitant invasive carcinoma of bladder and abdominal aortic aneurysm (AAA). We experienced two patients who were treated successfully with simultaneous radical cystectomy and AAA repair. The techniques required for the combined procedure and case reports are discussed. PROCEDURE: The goal of the one-stage operation was to minimize the risk of graft infection without compromising postoperative morbidity and mortality secondary to carcinoma of bladder. Initially pelvic lymph node dissection and radical cystectomy were performed. We preferred retrograde cyctoprostatectomy because most of the cystectomy procedure can be performed without opening the peritoneal cavity and the extent of the retroperitoneal dissection can be minimal. A single-stoma ureterocutaneostomy was preferable urinary diversion. Urinary diversions which utilize intestine such as ileal conduit or ileal urinary reservoir may cause contamination of a graft with bowel content and should be avoided. Before or after urinary diversion, aneurysmal resection and a bifurcated graft replacement were performed. The replaced graft was wrapped with the aneurysmal wall. The major omentum was mobilized and fixed in front of the graft, thereby serving as a protective barrier of the graft. A Dacron graft which was sealed with rifampicin-bonding gelatin was used to further reduce the risk of graft infection. RESULT: Two male patients were treated with the one stage radical cystectomy and AAA repair. Single-stoma ureterocutaneostomy and bilateral ureterocutaneostomy were selected as a urinary diversion. No major postoperative complications, except for paralytic ileus in one case, were observed. CONCLUSION: Our experience and reports of others indicate that radical cystectomy and simultaneous AAA repair can be safely performed with less morbidity than staged operations for the management of concomitant invasive carcinoma of bladder and AAA.

Aged↗
PubMedDate not supplied

[Bilateral retroperitoneal lymphadenectomy in tumors of the testis: anatomo-clinical considerations].

Bilateral retroperitoneal lymphadenectomy is usually indicated for non-seminomatous testis tumour at stage IIA and IIB. For seminoma is generally used radiotherapy, although some Authors prefer the surgical approach. Radical retroperitoneal lymphadenectomy must be bilateral, because metastatic cell can often spread to the contralateral lymph nodes. Lymphadenectomy is used not only for therapy, but also for staging: thus clinical evaluation and other diagnostic techniques are not always correct (30% of understaging). Permanent sexual disfunction can follow radical surgery, due to extensive retroperitoneal dissection and exeresis of lumbar sympathetic nerves; so it is proposed, for stage I tumors, a monolateral or limited retroperitoneal lymphadenectomy. Eight patients with non-seminomatous testicular tumours are reported by the authors; 2 (stage I) were treated with monolateral, 4 (stage IIA and IIB) with bilateral retroperitoneal lymphadenectomy; in 2 patients (stage IIC and IID) chemotherapy was followed by debulking surgery. Relapses were observed between 3 and 19 months. Sexual dysfunctions after surgery were present in 5 patients (69%); in all of these a bilateral retroperitoneal lymphadenectomy was performed.

Adolescent↗
PubMed2003

Retroperitoneoscopic nephroureterectomy for transitional cell carcinoma of the renal pelvis and ureter: Nagoya experience.

OBJECTIVES: To evaluate the efficacy of our new retroperitoneoscopic nephroureterectomy for patients with transitional cell carcinoma of the renal pelvis and ureter, we present the operative procedure and analysis of the clinical outcome of retroperitoneoscopy in 23 patients. METHODS: Twenty-three patients with transitional cell carcinoma of the upper urinary tract underwent retroperitoneal laparoscopic nephroureterectomy between February 2000 and February 2002. Patient age ranged from 44 to 83 years (mean 66.7). Each kidney was retroperitoneoscopically dissected en bloc, together with the perirenal fatty tissue, lymph nodes, and/or adrenal gland, without transecting the ureter. The lower ureter was resected with the bladder cuff transected using an ultrasonic scalpel and an endoscopic gastrointestinal automatic stapler. The dissected specimen was removed intact through a 6-cm-long original incision. RESULTS: The mean operating time was 4.8 hours, including 0.7 hours for complete removal of the ureteral end with the bladder cuff. The mean estimated blood loss was 304 mL. The mean time to recovery to normal activity was 18 days. In the mean follow-up period of 15 months, 2 patients died of cancer progression in the sixth postoperative month, 2 died of other causes, and 4 had recurrent transitional cell carcinoma of the bladder after surgery. CONCLUSIONS: Our retroperitoneal laparoscopic nephroureterectomy using an endoscopic gastrointestinal automatic stapler is a fast, low-risk, and minimally invasive procedure and might be an alternative to other laparoscopic techniques and open nephroureterectomy. However, long-term follow-up is necessary to confirm the efficacy for patients with transitional cell carcinoma of the renal pelvis and ureter.

Adult↗
PubMed1982

Lymphadenectomy for testicular carcinoma.

Since 50% of patients with testicular tumour have retroperitoneal metastases at the time of presentation, there has been little argument that the area of primary drainage requires further treatment following orchiectomy. Patients with nonseminomatous germ cell tumours in stages A and B are candidates for retroperitoneal lymphadenectomy because this procedure is of therapeutic value and allows accurate staging of the disease. The development of extremely effective modern, cyclic, multidrug chemotherapy for extensive nonseminomatous testicular tumour has led to a rethinking of the role of lymphadenectomy in treating testicular cancer. Clinical staging is still not 100% accurate even with modern techniques. Lymphadenectomy, therefore, continues to be an important step in managing patients with nonseminomatous germ cell tumours. These facts are endorsed by the authors' review of 72 cases of nonseminomatous germ cell tumours managed at McGill University teaching hospitals over a 10-year period. The authors also discuss the indications for retroperitoneal dissection.

Antineoplastic Agents↗
PubMed1986

Predictive model for prognosis in advanced diffuse histiocytic lymphoma.

The purpose of this study was to examine the validity of a predictive model for response to treatment and survival in advanced diffuse histiocytic lymphoma. One hundred twenty-seven consecutive patients with Ann Arbor stage II-IV diffuse histiocytic lymphoma, who completed treatment between 1974 and 1984 in one of four different Memorial Hospital combination chemotherapy protocols, were reviewed. The median follow-up time was 66.9 months for survivors (range, 21-153.1 months). Factors studied included: age; sex; Ann Arbor stage; prior therapy; B symptoms; serum lactic dehydrogenase (LDH); sites of initial disease; and tumor bulk. LDH was grouped accordingly (units/liter): low, less than 225; medium, 225-500; high, greater than 500. Each patient was assigned an overall level of site involvement (LSI) from the following mutually exclusive groups: group I, peripheral lymph node (PLN) (including +/- Waldeyer ring involvement, +/- spleen); group II, extranodal disease (EN) +/- PLN; group III, retroperitoneal lymph node (RLN) +/- PLN; group IV, bulky mediastinal disease (MED) +/- any other disease; group V, EN with RLN +/- PLN. The Ann Arbor staging system failed to dissect patient groups differing significantly in their prognosis. Serum LDH, LSI, and age were the only factors important for predicting response and survival after multivariate logistic regression and a parametric Weibull survival analysis. Using three levels of serum LDH and correlating them with the different LSI, four tentative "stages" differing significantly in their survival at 48 months were defined: stage I, low LDH, any LSI (80% alive); stage II, medium LDH, PLN, and/or EN (50% alive); stage III, high LDH, PLN, and/or EN or medium LDH, RLN +/- PLN +/- EN, and/or MED (35% alive); stage IV, high LDH, RLN +/- PLN +/- EN, and/or MED (15% alive). Identification of prognostic stages on the basis of LDH level and LSI will allow more accurate comparison of clinical trials for patients with advanced diffuse histiocytic lymphoma.

Adult↗