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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↗
PubMedDate not supplied

The mode of lymphatic and local spread of pancreatic carcinomas less than 4.0 cm in size.

To clarify the mode of lymphatic and local spread of small pancreatic carcinomas, we studied the histopathology of 33 patients with invasive ductal adenocarcinoma of the head of the pancreas less than 4 cm in diameter. Microscopically, lymph node metastases were found in 72.7% (24 of 33) of the patients: 17 patients had lymph node metastases at the first barrier and 7 patients had lymph node metastases at the second barrier. Capsular invasion was present in 21.2% (7 of 33) patients, retroperitoneal invasion in 84.8% (28 of 33) patients. Invasion to the common hepatic artery was identified in 9.1% (3 of 33) patients, and invasion to the portal vein system in 24.2% (8 of 33) patients. In addition, five of the seven patients with lymph node metastases at the second barrier had spread to the periaortic lymph nodes. Thus, even patients with small pancreatic cancers which were macroscopically confined to the pancreas showed microscopic extrapancreatic tumor extension, especially invasion to the retroperitoneal tissues and to the periaortic lymph nodes. This suggests that an aggressive surgical approach, including complete resection of surrounding connective tissues in the retroperitoneum and extensive lymph node dissection, is necessary to improve the surgical therapeutic results even for small pancreatic cancers.

Adult↗
PubMed1986

Angiomatoid malignant fibrous histiocytoma with extensive lymphadenopathy simulating Castleman's disease.

We report the association in a 10-year-old boy of an angiomatoid malignant fibrous histiocytoma (AMFH) of the left thigh with ipsilateral inguinal, pelvic and extensive retroperitoneal lymphadenopathy, and severe systemic manifestations. These include growth retardation, fever, severe anemia, hypergammaglobinemia, and hypoalbuminemia. At ultrastructural level the tumor was characterized by an abundance of myofibroblasts, occasional histiocytes, and small vessels with marked reduplication of the basal lamina. Biopsies of the inguinal and abdominal lymph nodes showed follicular hyperplasia and massive plasmacytosis indistinguishable from Castleman's disease (giant lymph node hyperplasia) of plasma cell type. The radical surgical excision of the primary tumor in the thigh resulted in the disappearance of the abdominal lymphadenopathy and a marked reduction in size of the pelvic lymph nodes with marked decrease of the gammaglobulins, thus proving that the nodal lesions were the expression of a reactive process to the tumor rather than a coincidental independent lymphoproliferative disorder. Retroperitoneal and pelvic node dissection was performed 1 year after the radical excision of the thigh tumor because of persistent pelvic lymphadenopathy and failure of serum immunoglobulins M and A to return to normal level, with a recent peak of IgA to twofolds that of normal value. Metastatic AMFH was found in the three pelvic nodes. One month postoperatively IgA returned to near normal level whereas IgM remained slightly elevated.

Castleman Disease↗
PubMed1989

Findings in lymph nodes of patients with germ cell tumours after chemotherapy and their relation to prognosis.

One hundred and forty six patients with advanced germ cell testicular tumours (38 seminomas and 108 malignant teratomas) treated by combination chemotherapy were studied over 10 years. Most of the improvement seen was in patients with malignant teratoma undifferentiated. In the most recently treated patients (1984-1987) 75% of drug resistant cases were malignant teratoma intermediate compared with 26% in the series treated between 1978-1983. The microscopic features of 52 primary testicular tumours were compared with features seen in excised retroperitoneal lymph nodes after completion of chemotherapy. Primary malignant teratoma intermediate had a higher incidence of viable malignancy in the excised tissue than malignant teratoma undifferentiated. Mature teratoma or fibronecrotic tissue within resected tissue was associated with a good prognosis. If resection was complete patients with drug resistant malignant teratoma intermediate had a more favourable prognosis than drug resistant malignant teratoma undifferentiated. It is advised that retroperitoneal node dissection should be considered in the management of patients with advanced germ cell testicular tumours, and that as complete a resection as possible be attempted to avoid the danger of missing residual disease.

Adolescent↗
PubMed2006

Retroperitoneal lymph node resection in patients with cervical cancer.

OBJECTIVE: To determine predictive factors precluding complete resection of metastatic lymph nodes identified by pre-operative imaging in patients with cervical cancer. METHODS: Retrospective clinical review of patients with cervical cancer with suspected metastases to pelvic and/or periaortic lymph nodes who underwent lymph node dissection by laparotomy at The University of Texas M.D. Anderson Cancer Center from September 1990-December 2004. RESULTS: A total of 104 patients were the subject of this analysis. Post-operatively, 25 patients (24%) had negative lymph nodes, 62 patients (60%) had macroscopically positive lymph nodes, one patient had microscopically positive (1%) and 16 patients (15%) had unresectable lymph nodes. Body mass index did not have any impact on successful resection of lymph nodes. On univariate analysis age (p=0.049) and size and location of the largest lymph node were associated with resection status (p=0.001 and 0.020). Logistic regression confirmed that chance of achieving a successful resection decreases with increasing age (p=0.046) and size of largest lymph node (0.002). CONCLUSIONS: The ability to completely resect suspected metastatic lymph nodes at the time of extraperitoneal lymph node dissection in patients with cervical cancer is associated with size and location of largest lymph node.

Adult↗
PubMed2001

Identification of pelvic lymph nodes with chlorophyllin after injection into the uterine cervix: an experimental and clinical study.

We investigated the value of staining retroperitoneal lymph nodes with chlorophyllin in normal dogs and in women with malignant uterine tumors undergoing lymphadenectomy. In dogs, after 0.3% chlorophyllin (sodium copper chlorophyllin) was injected into the canine uterus, the concentration of dye in the bloodstream was measured with a spectrophotometer and sections of stained retroperitoneal lymph nodes were examined using light and electron microscopy. The highest blood levels were detected at 4 hrs and nearly all of the chlorophyllin was gone from the bloodstream by 18 hrs but was retained in nodal macrophages for at least 4 days. No morphological changes were found in the excised lymph nodes. Twenty-four patients with cervical carcinoma and 20 patients with endometrial carcinoma undergoing radical hysterectomy and lymphadenectomy were divided into a lymphatic coloration group (23 patients) and a non-coloration (control) group (21 patients). In the lymphatic coloration group (0.3% chlorophyllin) was injected into the cervix 5 days before elective lymphadenectomy. There were no complications attributed to injection of the chlorophyllin. The number of dissected lymph nodes in the coloration group were greater than the control group (p<0.01) and the time of operation was shorter (p<0.01). These results suggest that chlorophyllin is safe and facilitates identification of retroperitoneal lymph nodes, allows more complete nodal excision and shortens the time of operation in patients undergoing radical hysterectomy with lymphadenectomy.

Adult↗
PubMed1998

Radiolabeled monoclonal antibody indium 111-labeled CYT-356 localizes extraprostatic recurrent carcinoma after prostatectomy.

OBJECTIVES: The sites of recurrent carcinoma of the prostate were localized with radiolabeled monoclonal antibody, and these sites were correlated with the response of patients treated with pelvic radiation after prostatectomy. METHODS: Radionuclide scans were performed with indium 111-labeled CYT-356, a monoclonal antibody that binds to prostate epithelial cells, in 48 men diagnosed with recurrent carcinoma detected by prostate-specific antigen (PSA) screening after radical retropubic prostatectomy. RESULTS: In 48 patients with recurrent carcinoma detected by PSA screening following radical retropubic prostatectomy, 73% had monoclonal antibody activity beyond the prostatic fossa, and only 3 patients (6%) had activity in the prostatic fossa alone; 65% had monoclonal antibody activity in pelvic lymph nodes despite the fact that lymph node dissections were pathologically negative at the time of prostatectomy in 90% of the patients; and 23% of patients had monoclonal antibody activity in abdominal and extrapelvic retroperitoneal nodes. Of 48 patients, 13 underwent external beam radiation therapy after monoclonal antibody scans. Six patients had scans showing activity beyond the field of radiation, and radiation therapy failed in 4 of these patients. Seven patients had scans with no activity beyond the field of radiation therapy, and radiation therapy failed in only 2 of these patients. CONCLUSIONS: The scans frequently show monoclonal antibody uptake in pelvic, abdominal, and extrapelvic retroperitoneal sites beyond the region of limited obturator node dissections and may account for the understaging and subsequent failure of radical prostatectomy in some patients. The monoclonal antibody scan seems to be a good predictor of which patients will respond to radiation therapy after radical prostatectomy, but because these patients often have nodal activity beyond the radiated field, this initial response may not be curative.

Adult↗
PubMed1988

Vascular anomalies and retroperitoneal lymphadenectomy (RLA).

In the past 7 years a total of 90 RLAs were performed in patients with testicular tumour and the vascular anomaly of the retroperitoneum was diagnosed in 10 cases. Attention is called to these vascular disorders which render the performance of lymph dissection difficult but can never influence the question of operability.

Blood Vessels↗
PubMed1994

[Laparoscopic lumboaortic retroperitoneal lymphadenectomy in testicular neoplasm].

Lumboaortic lymphadenectomy is a therapeutic alternative for patients with nonseminomatous testis tumors and its principal untoward effect is the loss of ejaculation. The anatomic knowledge of lymph node metastasis allows lower limit definition of aortic dissection, maintaining the diagnostic sensitivity and ejaculation. We report three patients with nonseminomatous testis tumors subjected to a reduced video-laparoscopic lumboaortic lymphadenectomy. An adequate amount of tissue was obtained in all and lymph node metastasis found in two. No complications occurred and patients were discharged 48 hours later. It is concluded that this technique is an alternative staging technique with low morbidity that allows a rapid patient discharge.

Adult↗
PubMed2001

Laparoscopic right hemicolectomy with radical lymph node dissection using the no-touch isolation technique for advanced colon cancer.

The treatment of advanced right-sided colon cancer presents numerous challenges for the surgeon who must aim to minimize the invasiveness of surgery, achieve curative resection, and prevent port-site recurrences. To overcome these issues, we performed a totally intra-abdominal laparoscopic right hemicolectomy with radical lymph node dissection based on a no-touch isolation technique. To perform this no-touch technique, we initially dissected the lymph nodes along the surgical trunk, then transected the transverse colon, terminal ileum, and mesentery without tumor manipulation. Finally, the right side of the colon was freed retroperitoneally. We performed this surgical technique on three patients and no intraoperative complications were encountered. Curative resection was achieved in all three patients, as curability A according to the Japanese Classification of Colorectal Carcinoma, and their postoperative courses were uneventful. Therefore, this novel technique proved to be both feasible and safe. Furthermore, it enabled us to minimize the invasiveness of surgery, while providing clear access to resect the right-sided advanced colon cancer.

Carcinoma↗
PubMed1999

Complications of laparoscopic procedures in urology: experience with 2,407 procedures at 4 German centers.

PURPOSE: The 4 most active centers of the laparoscopy working group of the German Urologic Association collected data about the complications associated with laparoscopic surgery in urology. MATERIALS AND METHODS: At 4 centers 2,407 laparoscopies or retroperitoneoscopies were performed as of May 1998, including 776 for varicocelectomy, 259 for cryptorchidism, 481 for pelvic lymph node dissection, 351 for nephrectomy/heminephrectomy renal pathology, 139 for renal cyst resection, 58 for ureteral procedures, 44 for adrenalectomy, 41 for nephropexy, 41 for lymphocele fenestration, 40 for retroperitoneal para-aortic lymphadenectomy and 187 for other operations. The complications were evaluated, listed according to the anatomical specificity and grouped with respect to the surgical step during laparoscopy. RESULTS: A total of 107 complications (4.4%) occurred. The re-intervention rate was 0.8% and the mortality rate was 0.08%. The complication rate depended on the difficulty of the procedure and averaged 1.0, 3.9 and 9.2%, respectively, for easy, difficult and very difficult operations. The majority were vascular injuries (1.7%) and visceral lesions (1.1%) followed by complications of healing and infection (0.8%). Only 0.2% of complications was associated with the access technique (trocar insertion), whereas most occurred during dissection (2.9%). The complication rate was 13.3% for the first 100 procedures and subsequently averaged 3.6%. CONCLUSIONS: Critical documentation of experience from several institutions, especially for an analysis of complications of urological laparoscopy, is important for the development of this surgical technique. The overall complication rate is comparable to other specialties. Future technical developments in trocar insertion, tissue dissection and control of bleeding with our improved training program will further reduce the complication rate.

Germany↗
PubMed1979

Complications of retroperitoneal lymphadenectomy.

Complications found in 47 individuals who underwent radical retroperitoneal node dissection were retrospectively analyzed. Our results indicate no mortality and an over-all complication rate of 29.7 per cent. An increased number of complications was noted in those patients who underwent elective appendectomy and in those node dissection above the renal vessels.

Adolescent↗
PubMed1997

Surgical strategy for carcinoma of the papilla of Vater on the basis of lymphatic spread and mode of recurrence.

BACKGROUND: Nodal status is one of the most important prognostic factors for carcinoma of the papilla of Vater. The pattern of lymphatic spread and mode of recurrence were analyzed by determining the frequency of nodal involvement and antemortem and postmortem examination of patients with recurrent disease. METHODS: From 1974 to 1994, 36 patients with carcinoma of papilla of Vater underwent pancreatectomy at the Kanazawa University Hospital. A precise evaluation of the nodal involvement was determined by means of careful pathologic review of the extended lymphadenectomy specimen. The mode of recurrence was determined by use of autopsy and radiographic examinations. RESULTS: Fifteen (42%) of 36 patients had nodal involvement. The lymph nodes with the highest metastatic rates were the inferior pancreaticoduodenal lymph nodes (number 13b) and the superior mesenteric lymph nodes (number 14) (13b, 31%; 14, 17%). There were no metastases in the perigastric lymph nodes. A significant relationship existed between the gross appearance of the primary tumor and nodal involvement (protruding, 22%; mixed type, 42%; ulcerative, 100%). The 5-year survival rates were 74% in the absence of nodal metastasis versus 31% with nodal metastasis. The 5-year survival rates for patients with protruding, mixed type, and ulcerative tumors were 75%, 49%, and 17%, respectively. Survival and recurrence were significantly correlated to gross appearance and nodal involvement. Retroperitoneal recurrence and liver metastasis were main modes of recurrence. CONCLUSIONS: Lymph node 13b is important in lymphatic metastasis to the superior mesenteric lymph nodes for carcinoma of papilla of Vater. Nodal dissection around the superior mesenteric artery is needed to improve the prognosis of carcinoma of papilla of Vater except in the nonexposed protruding tumor. Pylorus-preserving pancreatoduodenectomy may be indicated in patients with carcinoma of the papilla of Vater.

Adult↗
PubMed1993

Ejaculatory dysfunction after retroperitoneal lymphadenectomy.

The effects of retroperitoneal lymphadenectomy on ejaculation have been examined in 186 patients who had removal of residual masses after chemotherapy for metastatic non-seminomatous germ cell tumours. The results were analysed for significance using a chi 2 test of independence. Forty-one men (22%) permanently lost ejaculation postoperatively. The larger the size of the mass removed, the more likely the patient was to have ejaculatory failure (< 4 cm = 4%, 4-8 cm = 17%, > 8 cm = 58%; p < 0.005). Removal of bilateral masses was more likely to result in loss of ejaculation than unilateral masses (45 and 12%, respectively, p < 0.005). There has been significantly less postoperative ejaculatory dysfunction since 1984 when a nerve sparing dissection was introduced (before 1984 36%, since 1984 16%, p < 0.005). The incidence of ejaculatory dysfunction following retroperitoneal lymphadenectomy is therefore determined by the size and position of residual lymph node masses after chemotherapy and can be kept to a minimum by a careful nerve sparing operative technique.

Data Interpretation, Statistical↗
PubMed1991

Role of lymphadenectomy in renal cell carcinoma.

A hilar or limited lymph node dissection will not remove the primary lymphatic drainage area of either kidney. For a lymphadenectomy to have a therapeutic benefit, an extended dissection is required, particularly for right-sided tumors. An extended lymphadenectomy may not be justified in all patients with renal cell carcinoma, particularly those with small tumors (who rarely have lymphatic disease) or grossly positive nodes (who have a high risk of existing distant metastases). For some patients with T3 or V+ tumors and palpably normal retroperitoneal nodes, an extended nodal dissection may resect microscopically involved nodes and result in an improved survival rate. This hypothesis will not be tested appropriately until a randomized controlled study is performed.

Carcinoma, Renal Cell↗
PubMed2006

[Retroperitoneal approach and pelvic peritoneoectomy in the surgical management of advanced ovarian cancer].

OBJECTIVE: To share our experience in surgical management of advanced ovarian cancer applying a retroperitoneal approach and performing pelvic peritoneoectomy for the achievement of an optimal debulking in this disease. MATERIAL: Thirty eight patients age ranging from 36 to 77 years (average 55,7 years) staged: I - 2 (5,3%), II - 4 (10,5%), //III/ - 28 (73,7%) and IV - 4 (10,5%) had been operated on. Thirty patients presented without previous therapy, 3 - after total abdominal hysterectomy with adnexes, 1 - after supravaginal hysterectomy with adnexes, 1 - after unilateral adnexectomy and 3 - after neoadjuvant chemotherapy. METHODS: All 38 patients had been submitted to retroperitoneal approach during the laparotomy and it had been performed surgical procedures including various degrees of radicalness towards the pelvic structures (uterus, parameters vagina) with or without pelvic peritoneoectomy. The latter had been performed in 28 patients (73,7%). Selective lymph node dissection is carried out in 21 cases (55,3%), total omentectomy - in 36 cases (94,7%) and appendectomy - in 23 (60,5%). RESULTS: Maximal (no evidence of disease) and optimal (less than 2 cm lesion) cytoreduction is achieved in 23 (60,5%) and 8 (21,1%) patients, respectively - totally in 81,6% of all patients. The most common site of suboptimal (> 2 cm) residual masses is the anterior rectal wall and cavum Douglasi - 85,7%, Lymph node metastases is detected in 33%, metastases in omentum - in 75%, parametrial invasion - in 25%, vaginal metastases - in 8,3%, metastases in appendix and Fallopian tubes - in 47,8% and 8,8%, respectively and invasion of tumor's capsula - in 34, 2%. CONCLUSION: Retroperitoneal approach and pelvic peritoneoectomy are feasible and safe and lead to high percentage of optimal debulking, which is the main prognostic factor in advanced ovarian cancer patients.

Adult↗
PubMed2002

Lymph node metastasis in a gynecologic malignancy.

A radical hysterectomy was performed on patients with stage IA2 to IIB cervical cancer. For these patients, many histopathological parameters have been reported to be prognostic factors of cervical cancer, such as a pelvic lymph node (PLN) metastasis, the histological subtype, the tumor diameter, the depth of the stromal invasion, a lymph-vascular space invasion (LVSI), a parametrial invasion, a corpus invasion and a vaginal invasion. Ovarian cancer is normally treated with cytoreductive surgery followed by chemotherapy. Although physicians have paid a great deal of attention to intraperitoneal disease, a substantial number of ovarian cancers have reported to involve the retroperitoneal lymph nodes. Therefore, a lymph node metastasis has been introduced into FIGO staging. However, the prognostic significance of a lymph node metastasis is controversial. In order to determine the possibility of individualizing a pelvic lymph node (PLN) dissection in patients with endometrial cancer, the relationship between PLN metastasis and the various prognostic factors was investigated. In this paper, various prognostic variables including a lymph node metastasis were analyzed in cervical cancer, endometrial cancer, and ovarian cancer.

Endometrial Neoplasms↗