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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↗
PubMed1989

Pelvic and para-aortic lymphadenectomy in cancer of the ovary.

The role of the lymphadenectomy in ovarian carcinoma is widely discussed. The natural history of disease, its tendency to spread to peritoneal cavity and the lack of any reported series of careful node dissections undertaken during surgical exploration has made it difficult to establish the real significance of nodal metastatization and the optimal therapeutic approach for patients with positive nodes. At the Istituto Nazionale Tumori, Milan, 341 patients with ovarian carcinoma have been subjected to lymph node dissection. In 253 cases in which lymphadenectomy has been carried out during first surgery, the lymphonodal diffusion has been evaluated by stage, grading and histology. The incidence of lymphonodal metastases increased with the diffusion of the primitive tumour and this is particularly evident for the serous adenocarcinoma. From our data (as shown in our series of 173 cases Stage III with peritoneal and retroperitoneal diffusion) the lymphonodal involvement has to be considered as a negative prognostic factor, influencing survival in a statistically significant way. In the 88 patients subjected to radical lymphadenectomy during second-look surgery, after chemotherapy, a smaller percentage of positive nodes was observed as compared to untreated cases but, on the other hand, we documented a portion of positive nodes not sterilized by sistemic therapy. All this data confirm the necessity to perform radical lymphadenectomy not only as a staging procedure (because of low sensitivity of lymphangiography) but also as a therapeutic one for some patients.

Carcinoma↗
PubMed2004

[Late recognition of primary pancreatic carcinoid--case report].

Primary pancreatic carcinoid is an extremely rare pancreatic neoplasm. The most frequently it metastasizes to regional lymph nodes and liver. Carcinoids of the pancreas display various nonspecific imaging features (USG, CT), which can cause diagnostic problems. Authors report a case of late recognition of pancreatic carcinoid, in a woman who complained of abdominal pain and dyspeptic symptoms. The patient underwent pancreatoduodenectomy and dissection of tumor conglomerate in retroperitoneal space. The diagnosis was established by histopathological examination of the specimen after operation. So far the patient has not presented any clinical or radiological evidence of relapse.

Aged↗
PubMedDate not supplied

D1 versus D2 pancreatoduodenectomy in surgical therapy of pancreatic head cancer.

BACKGROUND/AIMS: The aim of this study was to evaluate the influence of standard pancreatoduodenectomy versus pancreatoduodenectomy with extended lymphadenectomy and the role of adjuvant therapy on survival in patients with ductal adenocarcinoma of the pancreatic head. In addition the problems related to resection are discussed. METHODOLOGY: A total number of 124 pts operated on between 1985 and 1999 were divided into three groups according to our different strategies. Standard resection (D1) was performed on 48 patients (group A), extended resection (D2) on 45 patients (group B) and combined treatment (extended resection plus adjuvant therapy) on 31 patients. The outcome of these three groups was compared with regard to postoperative morbidity and survival. RESULTS: There was no significant difference in terms of survival between group A and B, while adjuvant therapy (group C), achieved statistical significance as factor influencing survival, together with tumor stage. CONCLUSIONS: Our data suggest that no further improvement can be obtained on long-term survival by extended retroperitoneal dissection while chemoradiotherapy showed a doubling of median survival.

Adult↗
PubMed1996

An aggressive therapeutic approach to carcinoma of the body and tail of the pancreas.

BACKGROUND: Prognosis of patients with adenocarcinoma of the pancreatic body and tail is extremely poor. Anatomically, this part of the pancreas is thin, and cancerous invasion to the retropancreatic structures occurs easily. The majority of patients have residual tumor in the retroperitoneal tissues after conventional distal pancreatectomy. METHODS: Between 1962 and 1979, 10 patients with carcinoma of the pancreatic body underwent simple distal pancreatectomy. Between 1980 and 1990, 22 patients including 7 with distant metastasis underwent a more aggressive approach intended to achieve longer survival: distal pancreatectomy with extended dissection of the lymph nodes and adjacent structures, especially into the retropancreatic space. After 1984, intraoperative ŕadiation (IORT) by electron beam and chemotherapy by hepatic infusion plus systemic injection of mitomycin C (MMC) were added for 7 patients without distant metastasis. RESULTS: The 10 patients who underwent pancreatectomy between 1962 and 1979 all died within 20 months after their operations. Conversely, the patients treated with an aggressive approach between 1980 and 1990 survived longer; the 5-year survival rate for 15 patients without distant metastasis was 29%, though the 7 patients with distant metastasis died within 10 months of their operations. There were 4 long term survivors (> or = 5 years); 3 of whom received IORT and chemotherapy with MMC. Invasion to the retropancreatic soft tissues was present in 95% of the resected specimens from the 22 patients. However, invasion to the surgical margin at the posterior surface of the resected specimen was present in only 36% after extended resection of the retropancreatic structures. CONCLUSIONS: Survival improved for this disease after distal pancreatectomy with extended dissection, especially of the retropancreatic structures, adjuvant IORT, and chemotherapy had been performed.

Adenocarcinoma↗
PubMed2000

Prognostic significance of serous and clear cell adenocarcinoma in surgically staged endometrial carcinoma.

BACKGROUND: The serous adenocarcinoma (SA) and clear cell adenocarcinoma (CCA) of endometrium have been shown to be associated with high relapse rate and poor survival. It is not clear whether prognostic significance of these specific cell types of tumor is independent of retroperitoneal lymph node metastasis and other histopathologic prognostic factors in endometrial carcinoma. METHODS: We examined 240 consecutive patients with clinical stage I to stage III endometrial carcinoma who were treated prospectively with radical surgery and/or platinum-based chemotherapy. Surgery included extended hysterectomy, bilateral salpingo-oophorectomy, and systematic pelvic and paraaortic lymph node dissection. Prognostic significance of various histopathologic factors was determined by Cox regression analysis. RESULTS: SA/CCA were more frequently associated with deep myometrial invasion, high nuclear grade (G3), lymph-vascular space invasion (LVSI), and pelvic lymph node metastasis when compared to endometrioid adenocarcinoma (EMA). Of 216 clinically staged stage I or II disease, seven of 12 cases of SA/CCA had extrauterine disease. This incidence was much higher than that for EMA (46/204) (p<0.01). A multivariate Cox regression analysis revealed that cell type, grade, LVSI, and paraaortic node metastasis (PANM) were independent prognosticators. CONCLUSIONS: Prognosis of patients with endometrial carcinoma depends on cell type, grade, LVSI, and PANM. Poor prognosis for patients with SA/CCA is independent of lymph node metastasis and other histopathologic prognostic factors. The SA/CCA should be strictly discriminated from EMA.

Adenocarcinoma, Clear Cell↗
PubMed1992

[Lymph node metastasis in stage I ovarian cancer].

One hundred and sixteen cases of stage I Ovarian cancer from nine hospitals in all the China during Sept. 1982-April 1991 were investigated for their lymph node metastasis. There were 70 epithelial tumors, 36 malignant germ cell tumors, 8 from gonadal stroma and 2 undifferentiated. In 89 patients the ovarian tumor was confined to one ovary (stage Ia); in 6 cases both ovaries were involved (stage Ib); 21 cases was documented stage Ic. Systemic lymphadenectomy covering all pelvic groups of node together with aortic lymph node accomplished in 82 cases. In the remaining 34 cases only pelvic lymph node dissection was performed. There was 10.3 percent incidence of lymphatic metastasis in this series. The most common lesion was serous cystadenocarcinoma. All patients were follow-up for at least half year. The mortality rate in patients without lymph node metastasis was 2.8%, but 8.3% for those with lymph node metastasis. The clinical significance of retroperitoneal lymphadenectomy in early ovarian cancer was discussed.

Adolescent↗
PubMed1993

[Modified retroperitoneal lymph node excision in testicular tumors. Anatomy, surgical technique and results].

Between January 1988 and June 1992, 56 patients suffering from malignant testicular tumors underwent nerve-preserving retroperitoneal lymphadenectomy at the University Hospital in Innsbruck. The tumors were staged according to the nomenclature recommended by the Workshop for Staging and Treatment of Testicular Cancer (Lugano 1979). According to this nomenclature 23 patients had stage I and 33 patients stage II. Thirty-nine patients presented with malignant teratoma, 3 with seminoma and 14 with teratoma and seminoma. The patients with stage I tumors were treated after orchiectomy with nerve-preserving retroperitoneal lymphadenectomy according to the dissection fields of Weissbach et al. In cases of nodal involvement in the retroperitoneum (stage IIa and IIb) a retroperitoneal modified lymphadenectomy according to the margins of Colleselli et al was performed. Patients with stage IIc tumors were treated with three cycles of polychemotherapy. Subsequently, the residual tumor was removed and, if possible, a nerve-sparing lymphadenectomy was performed. Since the nerve-preserving technique was modified in accordance with the tumor stage, antegrade ejaculation could be preserved in 47 of the 56 patients. In 22 patients exocrine testicular function was assessed by sperm analysis. The findings for the patients with stage I and IIa were considerable. The patients who had undergone induction chemotherapy for stage IIb and IIc had poor exocrine testicular function. The follow-up time was 29 months. At follow-up none of the patients presented with recurrent retroperitoneal tumor. Only one patient was found to have tumor progression (solitary pulmonary metastasis 1.7%). These results show that nerve-preserving retroperitoneal lymphadenectomy is the treatment of choice in stage I non-seminomatous testicular tumors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Adult paratesticular sarcomas: a review of 21 cases.

We reviewed 21 patients more than 16 years old who were seen with a diagnosis of paratesticular sarcoma from 1958 to 1987. Of the patients 14 presented with primary disease and 7 with recurrent disease. The survival of the primarily treated patients was 58% at 5 years, calculated by the product limit method. Of the 14 patients with primary disease 13 had grade 3/4 or 4/4 sarcoma and 13 of 14 underwent initial radical orchiectomy. In addition, 6 of the 14 patients underwent an adjuvant operation or radiotherapy to the groin, or groin and scrotum, and none had local relapse. Some patients also had chemotherapy. Three patients underwent adjuvant retroperitoneal node dissection and 2 had microscopically positive nodes. All 3 patients remain without relapse. Six patients had relapse: 2 locally, 2 in the retroperitoneal nodes and 2 with distant metastases. Only 1 patient (with scrotal recurrence) was salvaged. Of the 7 patients referred with recurrent disease none was salvaged. In this series there is a 2 of 14 (14%) risk of local failure and a 4 of 14 (28%) risk of retroperitoneal relapse after radical orchiectomy. Since salvage has not proved successful, patients with rhabdomyosarcoma, intermediate or high grade malignant fibrous histiocytoma, or fibrosarcoma should be considered for adjuvant retroperitoneal node dissection. All patients should undergo adjuvant dissection or irradiation of the ipsilateral pelvic and groin nodes, and scrotum.

Adolescent↗
PubMed1994

Preservation of antegrade ejaculation in retroperitoneal lymphadenectomy due to residual masses after primary chemotherapy for testicular carcinoma.

We report 18 consecutive patients with testis cancer and retroperitoneal residual masses with normal tumor markers, who underwent lymphadenectomy. Aiming to preserve the antegrade ejaculation, we carried out surgical modifications which basically attempt to preserve: (1) both sympathetic lumbar trunks, (2) the superior hypogastric plexus and (3) some of the postganglionic branches. With a mean follow-up of 28.1 months (range 6-62 months), 15 (83.3%) of the 18 patients preserved ejaculation, without significant differences between ejaculation volumes before and after lymphadenectomy. At the present time, 3 of 4 possible patients have fathered children. Mass size seems to be an important predictive factor of ejaculation preservation. One patient relapsed in the retroperitoneal dissection area, representing a recurrence rate of 5.5%. The disease-free survival rate was 94.4%, and 1 patient died due to disease progression with lung recurrence. Thus preservation of ejaculation was possible in most of these patients.

Adult↗
PubMed2002

Site-dependent resection techniques for gastric cancer.

In addition to tumor stage and growth pattern, the tumor site is a major factor in determining the extent of resection and lymphadenectomy necessary in patients with gastric carcinoma. Total gastrectomy with D2-lymphadenectomy is the procedure of choice for tumors of the gastric corpus. Extended total gastrectomy with trans-hiatal resection of the distal esophagus is required for tumors of the proximal region; in these patients lymphadenectomy may also include splenic hilum and left retroperitoneal nodes. In patients with distal gastric carcinoma, a subtotal gastrectomy often achieves a complete tumor resection. Extended lymphadenectomy in these patients includes the retroduodenal and right para-aortic nodes in addition to a D2-dissection. In patients with early tumor stages, anatomically oriented limited resection techniques are increasingly important. The concept of the sentinel lymph node may result in more selective lymphadenectomy strategies in the near future [15]. For patients with a locally advanced disease, these surgical concepts must be evaluated within multimodal treatment protocols [16].

Adenocarcinoma↗
PubMed1985

Hematogenous metastasis of nonseminomatous germ cell testicular cancer.

A case is reported of a twenty-five-year-old man in whom paraplegia developed due to spinal metastasis from a nonseminomatous germ cell tumor immediately after retroperitoneal node dissection in which all nodes were found to be negative. This case emphasizes deficiencies in knowledge concerning the routes of metastasis of testicular tumor and points out that retroperitoneal lymphadenectomy is not an infallible staging procedure in patients with this disease.

Adult↗
PubMed1994

Fly-casting method of intracorporeal laparoscopic knot tying.

A simple technique for intracorporeal knot tying is discussed. Laparoscopic applications in urology initially began as simple diagnostic procedures to examine impalpable undescended testes and as an adjunct to help in management of intersex disorders. Subsequently, extirpative procedures have developed as technology has evolved and lymph node dissection, nephrectomy, and even assisted prostatectomy have been performed. As this experience increases it is only natural that reconstruction be the next step, and indeed case reports of ileal loop creation, pyeloplasty, and vesicoureteroplasty exist.

Humans↗
PubMed1999

[Quality of life after retroperitoneal lymphadenectomy in low clinical stages of nonseminomatous testicular tumors].

The surgical complications and quality of life in 139 patients who underwent primary retroperitoneal lymphadenectomy for clinical stage A and B1/B2 non-seminomatous testicular tumors during the period ranging from 1975 to 1997 were reviewed. Bilateral retroperitoneal lymphadenectomy was performed in 26 patients, and modified unilateral in 113 patients. There were 23 complications in 36 patients (16.5%) and only 1 case of surgery-related mortality. There were 28 early complications and 8 late complications. The most frequent minor complication encountered was superficial wound infection, whereas many of the major complications were related to small-bowel obstruction and atelectasis. The complication rate was lower in patients who underwent modified unilateral procedures than in those who had bilateral dissections (76.9:14.5%). The most prominent element of quality of life is preservation of normal ejaculation (69.8%), significantly better preserved in unilateral dissection (80.5:23.1%). This study reinforces the conclusion that primary unilateral retroperitoneal lymphadenectomy is and operation yielding minimal morbidity, excellent quality of life and no long-standing effects.

Humans↗
PubMed1990

[Aspiration biopsy of regional lymph node in bladder cancer].

Percutaneous transabdominal fine needle aspiration biopsy (FNAB) of the pelvic and retroperitoneal lymph nodes was performed in 116 patients with bladder cancer. Metastasis to the regional lymph nodes was determined by this method in 21 patients. FNAB was positive in 10 of 12 patients having unequivocally positive or highly suspicious lymphogram, and in 11 of 104 patients (11%) having normal lymphogram. The results of FNAB were compared to the finding of lymph node dissection (LND) in 51 patients. FNAB and LND were negative in 43 patients and positive in 5. Two patients were FNAB negative but LND positive, and the remaining one case was FNAB positive but LND negative. The correlation between cytological diagnosis of FNAB and histological diagnosis of LND was 94 per cent. The survival rate of the cases of FNAB positive and lymphography negative was significantly higher than that of lymphography positive (p less than 0.01). The metastatic site of 5 cases with bladder cancer who are alive now without disease after more than 3 years was under the common iliac node and the number of the involved nodes was within 3.

Aged↗
PubMed1987

False positive beta-human chorionic gonadotropin in testicular cancer.

Persistent elevations in serum markers after chemotherapy for germ cell testicular carcinoma indicate residual disease. We report on a patient with advanced seminoma with choriocarcinoma who had elevated serum beta-human chorionic gonadotropin (beta-HCG) and residual masses on computerized tomography scan after chemotherapy. Wedge liver resection and retroperitoneal node dissection yielded only necrotic tissue which assayed and immunoperoxidase stained positively for beta-HCG. Serum beta-HCG fell to undetectable levels postoperatively, and the patient remains disease-free after three years. Phagocytosis of necrotic tumor apparently released entrapped beta-HCG resulting in a false positive tumor marker.

Adult↗
PubMed2003

Angiosarcoma of the submandibular salivary gland: case report and review of the literature.

OBJECTIVES: The purpose of this report is to describe an example of angiosarcoma (AS) of the submandibular salivary gland. The clinical and immunohistopathologic features of these lesions are also reviewed. MATERIAL AND METHODS: A 17-year-old male high school student was admitted to our clinic with a 1-year history of a slow-growing, tender mass in the left submandibular region. Physical examination on initial presentation revealed a diffuse soft tissue mass 6 cm in diameter involving the left submandibular region. MRI analysis revealed a mass located superolateral to the submandibular salivary gland, measuring 4.0 x 2.0 cm2. The mass was excised completely together with the left submandibular salivary gland. Histopathologic analysis led to a diagnosis of AS. Immunohistochemical studies were also used to determine endothelial cell differentiation. Owing to the lateralized nature of the lesion, a left functional neck dissection was performed and postoperative radiotherapy was planned. RESULTS: AS is a malignant tumor of endothelial cell origin that may occur in any region of the body. The commonest sites include the extremities and the retroperitoneal space, with only 4% of AS tumors arising in the head and neck area. The submandibular salivary gland is an extremely rare location for this tumor. Based on a literature review, this case report represents only the second reported case of AS of the submandibular salivary gland. CONCLUSIONS: In most cases, radical surgery and postoperative radiotherapy are advocated to treat patients with AS tumors, with lymph node clearance recommended in cases of lateralized lesions In some patients, distant metastasis may occur after many years, which necessitates long-term follow-up. The prognosis is poor in most cases of AS.

Adolescent↗