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At least 865 records · Page 48Linked to original sources
PubMed1999

[A case report treated in two-stage operations for lung cancer associated with arteriosclerosis obliterans (ASO)].

A case of lung cancer complicated with ASO treated surgically in two-stage procedures was reported. A 74-year-old male was admitted to our institution with the complaint of intermittent claudication. Chest X-rays showed shadows of a mass in the right upper lung field, and the tumor was suspected to be bronchogenic adenocarcinoma on the basis of findings of bronchoscopic brushing smears (class IIIb). Angiography revealed about 90% atherosclerotic eccentric stenosis in infra-renal abdominal aorta. Right upper lobectomy and lymph node dissection (R 2 a) was underwent through posterolateral thoracotomy. Pathological diagnosis showed the tumor was well-differentiated papillary adenocarcinoma and pathological TNM classification was T2N0M0. The secondary abdominal-bilateral common iliac bypass using artificial graft was performed through retroperitoneal approach 6 weeks after the first operation. Postoperative course was uneventful and the patient was discharged one month after the second operation. He is now leading normal life with both no relapse of cancer and no symptoms at 2 years and half after this two-stage operations.

Adenocarcinoma↗
PubMed1980

High retroperitoneal lymphocele: unusual clinical presentation and diagnosis by ultrasonography.

A case of a mid lumbar lymphocele secondary to retroperitoneal lymphadenectomy for testicular carcinoma is described. The clinical picture was unusual and confusing in that the symptoms were gastrointestinal in nature. Ultrasound provided the diagnosis and guidance for aspiration. Although the most common operative source of lymphocele formation appears to be the pelvic lymphatics similar collections may arise from para-aortic and renal hilar dissections and produce unusual manifestations. Ultrasound is of established value in such cases.

Adult↗
PubMed1992

A test for the identification of relevant sympathetic nerve fibers during nerve sparing retroperitoneal lymphadenectomy.

We present a new intraoperative test for the identification of sympathetic nerve fibers relevant to ejaculation during nerve sparing retroperitoneal lymphadenectomy in patients with nonseminomatous testicular tumors. Electrostimulation of specific isolated postganglionic nerve fibers resulted in intraoperative ejaculation in 9 of 11 patients. Ejaculation was without tumescence in a noneruptive manner and was reproducible in most cases upon repeated stimulation. In 6 patients ejaculation resulted after stimulation of the L3 fiber and in 1 each after stimulation of the L1, L2 and hypogastric plexus. The test seems to be particularly useful in post-chemotherapeutic dissections or otherwise extended dissections when sparing of irrelevant fibers is to be avoided.

Adrenergic Fibers↗
PubMed1976

Prognosis for pathologic stage I non-seminomatous germ cell tumors of the testis managed by retroperitoneal lymphadenectomy.

The over-all 3,5 and 10-year survival rate for 87 patients with non-seminomatous germ cell tumors of the testis undergoing retroperitoneal lymphadenectomy was 90.5 per cent. Of the 72 patients receiving no form of therapy other than retroperitoneal lymphadenectomy after operative removal of the testicular tumor the 5-year survival rate was 90.8 per cent. The 5-year survival rates for these 72 patients, calculated according to the histologic characteristics of the primary tumor, were 74.4 per cent for 18 patients with embryonal carcinoma, 93.0 per cent for 36 patients with teratocarcinoma and 100 per cent for 18 patients with teratoma. Although no advantage could be demonstrated for bilateral lymphadenectomy as opposed to unilateral dissection, it is concluded that a modified bilateral dissection should be reserved only for tumors on the left side.

Adolescent↗
PubMed1985

A decade of progress, current problems and future perspectives in testicular cancer.

The author resumes the basic progress achieved in the classification, staging and treatment of testicular cancer in the last 10 years. It is already possible to evaluate with precision the extent of non-seminomatous tumours of the testicles by using serum and intra-cellular tumoral markers (immunoperoxydase and anti-peroxydase peroxydase technique), ultrasonography and CT scan. It should be possible to selective scan the metastases with anti-alpha-foeto protein and anti HCG antibodies. Greater precision is necessary in the staging of tumors than is generally admitted. Local invasion of blood vessels and lymphatics. Invasion of the cord. The number of invaded retro-peritoneal lymphnodes (greater than or less than 5). The size of the lymphnodes (2 cm). For stage I tumours: A. Good prognosis. Wait and see without lymphnode dissection or chemiotherapy. Year 1--monthly check-ups. Year 2--quarterly check-ups. Then annual check-ups. B. Poor prognosis. Limited biopsic retroperitoneal lymphnode dissection subsequently extended following the result of the frozen section histology. For stage II tumours (with histologic proof of lymphnode invasion) the author recommends radical lymphnode dissection, except in the case of very large tumours. Subsequently: Where the excision is complete and the prognosis good (number and size of lymphnodes) no immediate chemotherapy. The author prefers to save it should the patient suffer a relapse (same follow-up as for stage 1A). Where the excision is incomplete or where it is complete but the lymphnodes are numerous (greater than 5) or large (greater than 2 cm) chemiotherapy is recommended. Where the lymphnodes are bulky. The author recommends chemiotherapy initially to be followed by retroperitoneal radical dissection. The presence of persisting tumoral tissue would imply additional chemiotherapy. In advanced tumours, a bone-marrow sampling would precede very aggressive chemiotherapy followed by surgery for residual tumoral tissue, reinjection of the bone marrow and an additional course of chemiotherapy.

Antineoplastic Agents↗
PubMed1989

Radical retroperitoneal node dissection after chemotherapy for testicular tumours.

A group of 29 patients underwent salvage node dissection for residual retroperitoneal masses following orchiectomy and combination chemotherapy for advanced testicular cancer between 1980 and 1988. The results confirm that surgery for residual retroperitoneal masses following combination chemotherapy is worthwhile and whenever possible the sympathetic chain should be preserved.

Adolescent↗
PubMed1984

[A case report of retroperitoneal Schwannoma].

A 37-year-old man with complaints of lassitude and slight lumbal pain, who had been found to have a low abdominal median mass and was referred to our hospital by a practitioner, was admitted for further examination. IVP, examination of the gastrointestinal tract by the oral procedure and re-examination of the colon by a double contrast procedure revealed deviation of the right ureter, the urinary bladder and the alimentary tract. This mass was found to be a retroperitoneal tumor with central necrosis by low abdominal CT scanning and the low abdominal echography. The mass was removed easily, though it was slightly adherent to the anterior surface of the sacral bone. Pelvic lymphadenectomy was also done simultaneously. The removed mass was encapsulated by fibrous tissue, round in shape, 750 grams in weight (13 by 12 by 12 cm), evenly flat, elastic soft and contained 230 ml bloody exudate at the center. Histologically this mass contained areas where oval and spindle cells made palisading arrangement and areas where the tumor cells had no communication with each other and stroma was edematous. However, hyperchromatism of nuclei of tumor cells and high cellularity indicated this mass to be a malignant Schwannoma. Dissected lymph nodes had no metastatic involvement. Since the surgical margin was detected to be invaded by tumor cells, postoperative prophylactic irradiation of Linac (10 Me V-X, total doses 4,750 rads) was performed on the whole pelvis. This patient has been well and has had no signs of recurrence of tumor for 23 months after the operation. Ninety-four cases of benign retroperitoneal Schwannoma and thirty-six cases of malignant retroperitoneal Schwannoma reported in Japan are reviewed.

Adult↗
PubMed1992

[Retroperitoneal malignant lymphoma showing follicular type: report of a case].

We report a case of retroperitoneal follicular malignant lymphoma. A 59-year-old man visited the hospital with the chief complaint of a loss of body weight and left epigastric tumor. CT revealed a tumor, 9 x 6 cm, with non-homogeneous density in the left retroperitoneum. Since no clinical metastasis was identified, the tumor and the left kidney were resected en bloc with para-aortic lymph node dissection. Pathological diagnosis was non-Hodgkin follicular lymphoma of mixed small cleaved and large cell type with lymph node metastasis (2/23). The CHOP adjuvant chemotherapy (cyclophosphamide, adriamycin vincristine, Prednisolone) and the radiation therapy were performed after the operation. Recurrence in the mediastinal lymph node occurred 7 months after operation and radiation and the same adjuvant chemotherapy were performed and resulted in complete remission. The patient remained free of the tumor for 27 months at present.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

Resection of postchemotherapy residual masses and limited retroperitoneal lymphadenectomy in patients with metastatic testicular nonseminomatous germ cell tumors.

BACKGROUND: Adjunctive retroperitoneal lymphadenectomy (RPLND) plays an important role in the management of patients with metastatic nonseminomatous germ cell tumors (NSGCT). Currently, a bilateral RPLND is recommended for residual disease after chemotherapy. METHODS: The authors systematically have removed all residual masses and used intraoperative frozen section analysis to dictate the extent of surgery in the patients with NSGCT: If frozen section revealed necrosis, then a limited RPLND was performed; otherwise, a bilateral RPLND was attempted. RESULTS: Forty patients with metastatic NSGCT were studied. Of the 40 patients, 21 had necrosis identified in frozen section analysis of the residual mass(es), with 18 (85.7%) confirmed in permanent section. Two patients had microscopic viable germ cell tumor, and one had microscopic teratoma in the residual mass with the remaining RPLND specimen tumor-free. Overall, 18 of 45 patients (45%) had necrosis, 17 (42.5%) had teratoma, and 5 (12.5%) had viable germ cell tumor, identified in permanent section analysis. The median follow-up period was 36 months (range, 24-60 months). Of the 40 patients, 8 (20%) experienced recurrences, although none were in the retroperitoneum; 5 were chest recurrences (4 germ cell, 1 teratoma), 2 were retrocrural recurrences (teratomas), and 1 recurrence was with liver metastasis. Of the tumors of the 21 patients with frozen section analysis showing necrosis who underwent resection of residual mass(es) and limited RPLND, 3 (14.3%) experienced recurrences; 2 had germ cell tumors in the chest, and 1 had liver metastasis. The remaining 18 (85.7%) patients had no evidence of disease, with a mean follow-up of 33 months (range, 24-60 months). CONCLUSIONS: These results suggest that in patients with metastatic NSGCT of the testis, postchemotherapy resection of all retroperitoneal masses followed by limited RPLND if frozen section analysis shows only necrosis is a safe alternative to a difficult, potentially morbid bilateral dissection.

Adolescent↗
PubMedDate not supplied

Can selective retroperitoneal lymphadenectomy be better than unilateral retroperitoneal lymphadenectomy?

OBJECTIVE: To propose a new modality of retroperitoneal lymphadenectomy as a complementary treatment for patients with high risk, stage I nonseminomatous testicular tumor. MATERIALS AND METHODS: We studied 76 patients with stage I nonseminomatous testis tumor (T1-T4, NX, M0) treated by orchiectomy and retroperitoneal lymphadenectomy. Among them, 33 patients underwent unilateral retroperitoneal lymphadenectomy (URL) and 43 selective retroperitoneal lymphadenectomy (SRL). URL consisted in removing the lymph nodes located around the great vessel homolateral to the tumor (aorta or vena cava and iliac vessels), and anterior and posterior to the contralateral great vessel (aorta or vena cava). SRL was performed removing the lymph nodes located anterior and between the great vessels (aorta or vena cava) and laterally to the homolateral great vessel, extending the distal dissection until the level of inferior mesenteric artery. In these groups of patients, the incidence of disease recurrence, disease-free survival index, and frequency of post-operative aspermia were assessed. Mean post-operative follow-up time was 96 months. RESULTS: In the SRL group there was only 5% of aspermia versus 79% in the URL group (p < 0.0001). Tumor recurrence was observed in only 5 of the 76 patients and was not related to the surgical technique. The disease-free survival rate after the mean follow-up of 96 months was similar in both groups, being 94% in the SRL group and 93% in the URL group. CONCLUSION: The selective retroperitoneal lymphadenectomy constitutes an effective technique with a lower morbidity than unilateral lymphadenectomy, representing an excellent option for the management of patients with high-risk, stage I nonseminomatous testis tumor.

Journal Article↗
PubMed1998

[Stage-adapted radical principles in gastric carcinoma].

The aim of any surgical approach to gastric carcinoma should be a complete resection with no residual tumor left behind, that is, a R0-resection according to UICC. Complete tumor resection in this respect refers to the primary tumor as well as to the lymphatic drainage and requires an adequate safety margin. The indications for surgical therapy of gastric cancer and the choice of procedure should consequently be guided by the tumor stage. This requires accurate preoperative staging, which can today be achieved with endoscopic ultrasonography and surgical laparoscopy. Gastric carcinoma stage IA (mucosa carcinoma) can be cured by local excision. In patients with tumor Stages IB (submucosa carcinoma), II, and IIIA, lymph node metastases are common. Based on the available data, this group of patients benefits from radical resection and D2 lymph node dissection. The overall 5-year survival rate of 50% for the large number of patients undergoing gastric resection for cancer seems to demonstrate convincingly the value of extended lymphadenectomy. In patients with advanced gastric carcinoma, that is, tumor stages IIIB and IV, a complete tumor removal usually can not be achieved by surgical dissection. Neoadjuvant therapeutic modalities should consequently be assessed in these patients. Based on tumor location and growth pattern, a total gastrectomy is the procedure of choice in patients with middle and proximal third gastric cancer. A subtotal gastrectomy may be performed in patients with tumors of the distal third and "Laurens intestinal type" growth pattern. The distal site of the main lesion must be investigated carefully to ensure that incidental concomitant lesions are not overlooked. Depending on the individual tumor situation, the gastrectomy can be extended toward varying portions of the distal esophagus or the pancreas, preserving splenectomy and resection of the retroperitoneal lymph nodes. The high incidence of locoregional recurrences and distant metastases after curative surgery for gastric cancer calls for improved locoregional control and systemic adjuvant treatment.

Gastrectomy↗
PubMed1998

Retroperitoneal and pelvic extraperitoneal laparoscopy: an international perspective.

OBJECTIVES: To assess technical preferences and current practice trends of retroperitoneal and pelvic extraperitoneal laparoscopy. METHODS: A questionnaire survey of 36 selected urologic laparoscopic centers worldwide was performed. RESULTS: Twenty-four centers (67%) responded. Overall, 3988 laparoscopic procedures were reported: transperitoneal approach (n = 2945) and retroperitoneal/extraperitoneal approach (n = 1043). Retroperitoneoscopic/extraperitoneoscopic procedures included adrenalectomy (n = 74), nephrectomy (n = 299), ureteral procedures (n = 166), pelvic lymph node dissection (n = 197), bladder neck suspension (n = 210), varix ligation (n = 91), and lumbar sympathectomy (n = 6). Mean number of total laparoscopic procedures performed in 1995 per center was 41 (range 5 to 86). Major complications occurred in 49 (4.7%) patients and included visceral complications in 26 (2.5%) patients and vascular complications in 23 (2.2%). Open conversion was performed in 69 (6.6%) patients, electively in 41 and emergently in 28 (visceral injuries, n = 16; vascular injuries, n = 1 2). Retroperitoneoscopy/extraperitoneoscopy is gaining in acceptance worldwide: in 1993, the mean estimated ratio of transperitoneal laparoscopic cases versus retroperitoneoscopic/ extraperitoneoscopic cases per center was 74:26; however, in 1996 the ratio was 49:51. CONCLUSIONS: Retroperitoneoscopy and pelvic extraperitoneoscopy are important adjuncts to the laparoscopic armamentarium in urologic surgery. The overall major complication rate associated with retroperitoneoscopy/extraperitoneoscopy was 4.7%.

Humans↗
PubMed2000

Lymphadenectomy in ovarian cancer.

Current guidelines for the surgical staging of ovarian cancer include the removal of retroperitoneal lymph nodes (pelvic and aortic). In most centres this is achieved by means of laparotomy, but advanced laparoscopic techniques have also been performed and still further prospective controlled studies with long-term follow-up are necessary to validate the efficacy. Lymph node sampling, short of complete dissection, should be avoided because it may be insufficient to detect metastasis. In any case, laparoscopic lymphadenectomy as well as open surgery, should be in the hands of properly trained subspecialists in gynaecologic oncology. Of 97 patients with ovarian carcinoma studied in our hospital, 68% were treated by means of complete staging laparotomy (FIGO). Lymphadenectomy was spared in 14 cases with stage I tumours (mainly serous) without changes in overall survival. In 15% metastases in pelvic lymph nodes were present. In the same proportion aortic lymph nodes were positive. In 5.5%, aortic metastases were present in the absence of pelvic involvement.

Female↗
PubMed1996

Results of extensive surgery for pancreatic carcinoma.

BACKGROUND: Since 1973, 210 patients with pancreatic carcinoma have undergone surgery in our clinic, including 144 with carcinoma of the head of the pancreas. Of these 144 patients, macroscopic curative resections were performed on 53 (36.8%). Five patients (9.4%) died within 30 postoperative days, and an additional 3 (5.7%) died within 60 days. The overall median survival was 13 months. Eight of the patients who underwent macroscopic curative resection survived 5 years, giving a 5-year survival rate of 27.4% using the Kaplan-Meier method. The 5-year survival rate was 39.7% after a microscopically curative resection and 0% after a microscopically noncurative resection. METHODS: Outcome was compared based on the extent of pancreatic cancer by constructing survival curves according to the general rules published by the Japan Pancreas Society. RESULTS: There was no statistically significant difference in survival based on tumor size or stage. However, there was a significant difference in the survival of patients with the absence (so) or presence (se) of invasion to the anterior capsule of the pancreas, the absence (rpo) or presence (rpe) of invasion of the retroperitoneal tissue, the absence (ew0) or presence (ew2) of invasion at the surgical margin of resection, and the extent (n0 to n2) of lymph node metastasis. CONCLUSIONS: The results of this study suggest that extended radical pancreatectomy may be indicated for patients with pancreatic carcinoma because standard dissection may fail when the tumor has spread to the retroperitoneum or extrapancreatic nerve plexus.

Adult↗
PubMed1989

Use of limited retroperitoneal lymphadenectomy in nonseminomatous germ cell tumors.

In an attempt to prevent ejaculatory dysfunction associated with retroperitoneal lymphadenectomy, the dissection has been modified to stay above the inferior mesenteric artery. Using this approach, there has been no adverse impact on survival (at least 18 months follow-up) in 18 patients with nonseminomatous germ cell tumors.

Ejaculation↗
PubMed1996

Nonbiliary laparoscopic gastrointestinal surgery: role of CT in diagnosis and management of complication.

OBJECTIVE: Laparoscopic techniques are evolving for a wide range of surgical procedures outside the biliary tree. We describe the CT findings of important complications detected after nonbiliary laparoscopic gastrointestinal surgery and the role of CT in their management. MATERIALS AND METHODS: Over a 3-year period, 209 patients had nonbiliary gastrointestinal laparoscopic procedures (partial or total colectomy, splenectomy, Nissen fundoplication, lymph-node dissection, herniorrhaphy, appendectomy, and exploratory laparoscopy). Thirty-seven abdominopelvic CT studies were performed on 18 (9%) of these patients for complications after surgery. In all cases CT findings were reviewed and correlated with follow-up surgical, clinical, or interventional radiologic findings. RESULTS: Fourteen major complications were detected on CT in 12 of 18 (67%) patients who had undergone partial or total colectomy (6/25, 24%), splenectomy (4/41, 10%), appendectomy (1/15, 7%), or lymph-node dissection (1/43, 2%). These complications included seven abscesses (three of the splenic bed, two of the pelvis, one of the liver, and one of the abdominal wall). The remaining complications were four hematomas (two in the abdominal wall caused by trocar site bleeding, one intraperitoneal, and one retroperitoneal), one case of colon perforation, one case of pancreatitis, and one case of splenic infarction. Percutaneous abscess drainage was performed successfully in seven patients, using CT guidance in six. Six patients had negative CT studies. CONCLUSION: Major complications may occur after complex nonbiliary laparoscopic procedures and are probably related to lack of experience with new surgical techniques. In this study, such complications occurred most often after laparoscopic colectomy and splenectomy. CT valuable in their diagnosis and in the management of abscess collections.

Adult↗
PubMed1983

Clinically unrecognised renal carcinoma: aspects of tumor morphology, lymphatic and haematogenous metastatic spread.

In a series comprising 235 clinically unrecognised renal carcinoma, metastatic spread was found in 56 cases (24%). In 82% of cases with metastases the spread involved more than one site. Lymphatic spread was diagnosed in 37 patients. Lymph node metastases were usually multiple and multifocal and were almost as common in the mediastinum as in the retroperitoneal space. In cases with involvement of these sites and/or supraclavicular nodes, concomitant metastases in the lungs were observed in 86% and in other organs in 11%. Since lymph node invasion is a strong indicator of systemic spread, the therapeutic benefit of radical lymphadenectomy seems very low, whereas a limited unilateral dissection is justified mainly for its value as a staging procedure.

Adenocarcinoma↗
PubMed1994

Lymph node metastasis in stage I ovarian carcinoma.

One hundred and sixteen cases of stage I ovarian cancer from 6 hospitals in China were investigated for their lymph node metastasis from September, 1982 to April 1991. Of them, 70 had epithelial tumor, 36 malignant germ cell tumor, 8 gonadal stroma, and 2 undifferentiated tumor. Ovarian tumor confined to one ovary (stage Ia) in 89 patients, both ovaries involved (stage IIb) in 6, and documented stage Ic in 21. Systemic lymphadenectomy involving all pelvic groups of node together with aortic lymph node was accomplished in 82 patients. In the remaining 34 patients, pelvic lymph node dissection was performed. The incidence of lymphatic metastasis was 10.3% in this series. Serous cystadenocarcinoma was the most common lesion. All patients were followed up for at least half year. The mortality rate in patients with and without lymph node metastasis was 8.3% and 2.8% respectively. The clinical significance of retroperitoneal lymphadenectomy in early ovarian carcinoma was discussed.

Adolescent↗