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PubMed2001

[Surgical treatment of differentiated thyroid gland carcinoma. Technique and morbidity in paratracheal lymph node excision].

BACKGROUND: The extent of cervical lymphadenectomy in treatment of differentiated thyroid cancer is controversial. Technique and results of paratracheal lymphadenectomy are presented to demonstrate safety of cervical lymphadenectomy procedures. PATIENTS AND METHODS: 68 Patients with differentiated thyroid cancer underwent total thyroidectomy and extended lymphadenectomy in a standardized technique. The pre- and paratracheal and the lateral lymph node compartments were cleared. RESULTS: Permanent pareses of recurrent laryngeal nerve or permanent hypocalcaemias were not observed. 3 patients developed transient recurrent nerve palsy, 26 patients transient hypocalcaemia (Ca2+ > 1.7 and < 2.2 mmol/l). In 3 patients mild voice disturbances, probably due to superior laryngeal nerve dysfunction were observed. In 1 patient short-time tracheotomy was performed. 1 patients showed permanent Horner's syndrome. CONCLUSIONS: Thyroidectomy with extended lymphadenectomy achieves removal of all cervical tumor masses without relevant morbidity. The distribution of metastatic lymph nodes underlines the necessity of extended lymphadenectomy.

Follow-Up Studies↗
PubMed1989

[Improved actuarial results in the treatment of kidney cancer by systematic lymph node excision].

From January 1st 1970 to December 31th 1985, 706 nephrectomies for renal cell carcinoma have been performed by the staff of the urologic clinic of the University of Erlangen-Nürnberg. 222 nephrectomies by lumbal and 484 by transabdominal incision. The following study compares the results of two groups of patients, who all have been operated transabdominally with curative goal (this means that there was no evidence for distant metastases). The two groups differ in the character of the associated lymph node dissection. The first group consists of patients on whom we performed a systematic lymph node dissection (LAS, n = 291). The second group consists of those patients on whome we performed a facultative lymp node dissection (LAF, n = 193). In this prospective study of postoperative survival rates, significantly better results are obtained in the LAS-group. The survival rates according to the stage of the tumor (Robson-classification) show that stage I and II profit most of the extended lymph node dissection. The bad prognosis for stage IIIa patients, determinated by tumor invasion into the renal vein, will not be changed after extended lymph node dissection. Patients with positive regional lymph nodes (stage IIIb + c) have a significantly better prognosis during the first three years after nephrectomy, obviously as the result of reduce tumor volume, but the benefit does not last over a longer period as 5 years. According to our results we are convinced that the systematically extended lymph node dissection is an important curative measure in the surgical therapy of renal cell carcinoma.

Actuarial Analysis↗
PubMed1989

[Axillary lymph node excision in breast cancer].

We report on 264 patients with operable breast cancer, treated between 1980 and 1984 at the First Clinic of Obstetrics and Gynecology in Vienna. The operation was in all cases a modified radical mastectomy. The patients were randomized in two groups. In one group of 140 patients, the lymphatic tissue of the axilla was marked by technetium-99 antimonsulfide and these patients were operated on a gammacamera. The other group of 124 patients was not marked. This unspecific imaging of lymph nodes enabled us to increase the average number of removed lymph nodes by 25% in the marked group. In this group the amount of lymph-node-positive cases was 50.7% compared to 37.4% in the unmarked group. This difference may find its explanation in the higher number of lymph nodes removed. All other prognostic parameters in both groups showed no significant difference. After an observation period of 5 years or longer no difference in survival rate, disease-free interval, local and regional recurrence or distant metastases was found. This seems surprising because the number of lymp-node-positive cases was higher in the marked group, which according to oncological principles should result in a lower prognostic score. The explanation may be that a higher number of identified and removed lymph node metastases may bring those patients the advantage of modern adjuvant therapy and therefore a better prognosis.

Austria↗
PubMed1995

[Surgical technique of extended lymph node excision (type R2 and R3) in gastric adenocarcinomas].

Extended R2 (and accessorily R3) lymphadenectomy is rarely used by western surgeons for curative surgical treatment of gastric adenocarcinomas and has been mainly developed by Japanese surgeons. We report the technical procedure of this extended lymphadenectomy. This description includes a review of the practical aspects and some comments concerning morbidity and indications.

Adenocarcinoma↗