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PubMed1990

[Current problems and complications of extensive uterine and pelvic lymph node excision for cancer of the uterus based on a 25-year case load].

The authors studied the complications and other current problems of surgery of 212 cases subjected to Wertheim-Okabayashi operation. Of them 118 were cervix cancer in stage I and 90 in stage II and 4 were cancer of the uterus body in stage II. Two cases of operation death, 1 case of ureter injury and 1 case of large vessel injury occurred. Four ureteral and 1 late rectal-vaginal fistula developed. Difficulty of urination was observed in 49 cases. Those who consider surgical monotherapy best, hold the postoperative percutaneous irradiation necessary only in cases of metastases of the lymph nodes.

Female↗
PubMed2001

[Parasternal lymph node excision in breast cancer].

Comparative analysis of the results of videothoracoscopic parasternal lymphadenectomy and standard mastectomy by Urban--Holdin is presented. In November 1995 to December 1999 205 videothoracoscopic parasternal lymphadenectomies were performed (96--on the left, 104--on the right). Central and medial location of breast cancer was indication for this operation. Age of the patients ranged from 23 to 73 years. Surgery was performed under intravenous anesthesia in the conditions of artificial lung ventilation with separate lung intubation. Mastectomy was performed as the first stage. Further, thoracoports were introduced into pleural cavity in the 5th intercostal space along medioclavicular and mediaxillar lines and in the 4th intercostal space along anterior axillar line. Parietal pleurotemy was performed parallely to internal thoracic vessels, parasternal fat and lymph nodes were removed en-block. Parasternal lymph nodes were involved in 40 (19.5%) patients. The spirometry, cardiomonitoring which were used pre-, intra-, postoperatively demonstrated that parasternal thoracoscopic lymphadenectomy is less traumatic and effective as diagnostic method than mastectomy by Urban--Holdin. Parasternal thoracoscopic lymphadenectomy can be recommended as a method of choice in medial and central breast cancer.

Adult↗
PubMed1981

[Skin incision in axillary lymph node excision].

The described T-shaped skin incision lines make a wide representation of the axillary groove possible, which is the supposition for a radical lymphonodectomy. There was no morbidity in the post-operative period. In addition to it the T-shaped skin incision lines can be combined easily with the dissection incontinuity for treatment of malignant melanomas of the skin with high risk and favourable anatomic positions of the lesions.

Axilla↗
PubMed1994

[Prophylactic lymph node excision in cutaneous melanomas of the lower limbs].

An analysis of 67 cases of skin melanoma of feet and legs aggravated by the risk of regional metastatic spreading established a significant improvement in five-year survival (over 30%) in patients who had undergone prophylactic lymphadenectomy. Indications for preventive surgery are suggested and rationale of its extent is discussed.

Adult↗
PubMed1996

[Value of regional lymph node excision for prognosis of advanced malignant melanoma treated by perfusion of the extremity].

Staging by means of preoperative clinical screening will always stage melanoma study patients too favourably. Only a postoperative histopathological staging by means of lymphadenectomy will allow a correct stage-correlated patient prognosis. Lymphadenectomy does not prolong overall survival (95% confident intervals +/-6.6% to +/-25%) however prolongs recurrence free survival.

Antineoplastic Agents↗
PubMed1990

[Retrograde ejaculation as a cause of aspermia following retroperitoneal lymph node excision and the effective use of alpha sympathomimetic drugs].

Retroperitoneal lymphadenectomy may produce in the majority of patients an irreversible loss of normal ejaculation due to lesion of presacral sympathetic nerve fibers. Libido and orgasm did remain unchanged. In 14.3% of the patients a retrograde ejaculations could evaluated. By application of alpha-sympathicomimetic drugs this could reversed to an antegrade ejaculation. However, fertility was altered strongly because of motility loss.

Administration, Oral↗
PubMed1989

[Lumpectomy with axillary lymph node excision and subsequent irradiation of the small breast cancer].

The technique of lumpectomy with axillary lymphonodectomy and postoperative irradiation is discussed in this paper and is compared to quadrantectomy or bilaterally restricted subcutaneous mastectomy in cases of small-size mammary carcinoma. A critical appraisal is made of the authors' own concept of indication, with reference being also made to the problem of the non-invasive form.

Breast Neoplasms↗
PubMed1990

[Functional cervical lymph node excision with section of the sternocleidomastoid muscle].

Based on 7 cases, the authors update the low section and subsequent suture technique of the sternocleidomastoid muscle in conservative cervical lymphadenectomy, principally for differentiated thyroid cancer. Due to the good exposure obtained, this technique permits functional clearance with excellent visualisation of the structures to be preserved and is associated with very minor functional sequelae. A review of the literature confirms the perfect feasability and reproducibility of this technique and justifies its use from a cosmetic viewpoint.

Adult↗
PubMed1990

[Significance of the intercostobrachial nerve in axillary lymph node excision].

The anatomy of the intercostobrachial nerves is described; generally two or three of them exist on each side. We followed up 101 modified radical mastectomies with axillary dissection: 53 cases (52.5%) had no sensory disturbances of the intercostobrachial nerves, 48 (47.5%) had either a loss of sensibility or dysesthesias. 8 patients (7.9%) showed an intercostobrachial nerve entrapment syndrome grade I, whereas 4 (3.96%) patients complained of a more intense pain syndrome (2 x grade II, 2 x grade III).

Adult↗
PubMed1995

[Lymphatic congestion of the conjunctiva after pre-auricular lymph node excision].

PATIENT: A 68-year-old woman presented with massive congestion of lymphatic vessels of temporal inferior conjunctiva two months after extirpation of the parotic gland for an aciniform epithelioma on the same side. Clinical findings of the right and left eye were unremarkable otherwise. The congestion resolved spontaneously. METHODS: Patent Blue 2.5% was injected into the subconjunctiva in 5 mm distance of the limbus. The superior conjunctiva revealed a normal circular pattern of lymphatic vessels. In the temporal inferior conjunctiva massively congested lymphtic vessels could be demonstrated. This area is normally drained by the regional lymphnodes now interrupted by the surgery. CONCLUSION: The individual anatomy of the lymphatic vessels may be of significance also in filtering surgery. Especially radial conjunctival cuts may interrupt the lymphatic vessels. The regional lymphatic drainage from the temporal inferior conjunctiva is blocked by massive surgery of the parotic gland.

Aged↗
PubMed1991

[Combined gastrectomy with extensive lymph node excision in the surgical treatment of cancer of the stomach].

The authors discuss experience in combined gastrectomy in 206 patients with gastric carcinoma. They encountered 72 various postoperative complications which were not fatal. Fourteen patients died, which made up a total postoperative mortality of 6.8%. The most frequent and threatening complication was incompetence of the esophago-intestinal++ anastomosis, which occurred in 17 cases (8.3%) and was the cause of death of 6 patients (42.9%). The incidence of purulent and pleuropulmonary complications was 19.9 and 3.4%, respectively. Extensive lymphadenectomy was performed in combined gastrectomy in 40 cases, which accounted for 42.6% of all combined interventions. The incidence of complication was lowest in this group of patients (15%), and there were only 2 fatal outcomes (5%). The authors believe that total gastrectomy with omentectomy, splenectomy, resection of the lower esophagus, and extensive lymphadenectomy is the method of choice in surgical treatment of gastric carcinoma.

Adult↗
PubMed1994

[Nerve preserving retroperitoneal lymph node excision in non-seminomatous testicular cancer].

Thirty-nine patients with a non-seminomatous testicular tumor underwent retroperitoneal lymphadenectomy (RPLND) between 12/90 and 7/93. Twenty-four patients with stage I disease were operated on with a modified nerve-sparing RPLND, while 7 patients with stage IIA and 8 patients with stage IIB had bilateral RPLND. Twelve of fifteen patients with stage IIA and IIB had preservation of their sympathetic postsynaptic fibers. Intraoperative electric stimulation of the fibers resulted in ejaculation in 25/26 patients. Semen analysis revealed 21 patients with necrospermia and maturation arrest, while 3 had aspermia. Antegrade ejaculation was restored after 1.1 months following nerve-sparing RPLND and 7 months following radical RPLND. Ejaculation did not return in one patient. No patient showed relapse. Our results show that the sympathetic postsynaptic fibers can be preserved during RPLND. Nerve-sparing RPLND is superior to radical and modified RPLND with regard to preservation of ejaculation without compromising the radicalness of the tumor surgery.

Adult↗
PubMed1999

[Retroperitoneal recurrence of non-seminomatous testicular tumors: computerized tomography findings before retroperitoneal lymph node excision].

PURPOSE: In relapsing testicular cancer, additional chemotherapy is followed by abdominal CT. If residual lesions are found, retroperitoneal lymphadenectomy is considered. We studied retrospectively whether morphological criteria can help in selected cases in deciding about lymphadenectomy by distinguishing between vital tumor, scarring and mature teratoma. METHODS: In 26 patients who had been treated by salvage chemotherapy and retroperitoneal lymphadenectomy for non-seminomatous testicular cancer between 1990 and 1997, abdominal computed tomography and histology were correlated. RESULTS: Histological examination found scarring in 10 patients, vital tumor in 6, mature teratoma in 4, and simultaneous teratoma and vital tumor in 6. A single CT criterion for distinguishing between these histologies was not identified. In two patients with large masses which were partly cystic and partly solid vital tumor and teratoma were verified. Scarrings may be expected in cystic lesions at the level of the renal hilus which are lined by a thin and smooth wall. Size did not matter. CONCLUSION: Accurate differentiation between vital tumor and necrosis was not possible. Before lymphadenectomy CT, however, localised lesions.

Adolescent↗
PubMed1994

[Lymphocele and complications after pelvic/para-aortic lymph node excision in relation to closure of the peritoneum].

From January 1988 to December 1991, 343 women were operated for genital carcinoma at the 1st Gynaecological Department of the University Munich. Additionally to the corresponding cancer operations, pelvic or pelvic and paraaortic lymphadenectomy was performed. In a postoperative systematic and prospective study with ultrasound, we detected a high incidence of 48% of postoperative lymphocysts. Only a few were symptomatic and even less required therapy. In this study we were especially interested in the influence of closure of the pelvic peritoneum on the incidence of lymphocysts. Thus, we inaugurated a prospective study in 1991 with 49 patients with an open peritoneum and compared these results to 294 women who had standard closure of the peritoneum. There was a significantly higher rate of lymphocysts in patients with peritoneal closure (45.2%) in comparison to 20.4% lymphocysts in patients without peritoneal closure. In the study group (open peritoneum) 6.1% of the patients with lymphocysts showed symptoms, only 4.1% needed therapy. In the control group (closed peritoneum), 14.6% of the patients with lymphocysts were symptomatic and 8.2% needed therapy. These differences are not statistically significant. Other complications such as haemorrhage, fever or ileus were comparable in both groups. Our results do not supply sufficient proof, that leaving the peritoneum open significantly reduces symptomatic lymphocysts.

Adult↗
PubMed1992

[Multiple localization and lymphatic involvement of papillary micro-carcinoma of the thyroid. Results of total thyroidectomy with bilateral lymph node excision. Apropos of 38 patients].

This study involved 38 patients with occult papillary carcinoma of the thyroid gland treated by total thyroidectomy and bilateral prophylactic neck dissection. The histological results show the glandular multicentricity on either side, both in single nodule (65%) and in multinodular goiter (73.3%). High risk of cervical spreading clearly appears in papillary carcinoma (18.4% of the patients) even in these small foci (lower than 10 mm). Topography of involvement brings into prominence two main territories: paratracheal, mid and lower jugularly nodes (involved in 92.8% of the positive dissections).

Adolescent↗
PubMed1992

[Recurrence of cervical lymph node involvement in surgically treated thyroid cancer. Uselessness of routine cervical lymph node excision (medullary carcinoma excluded)].

From 1966 throughout September 1990, 753 patients underwent surgery for thyroid carcinoma, in the same institution, covering all pathological types. Complete follow-up was achieved in 96% of them, being at least 7 years in 50% of cases. 599 (80%) are currently alive. Neck dissection was not routinely done, except for medullary thyroid carcinoma, but rather selectively, if nodes were palpable either pre or intraoperatively, and also (since oct. 1983 i.e. the last 400 cases) if, after routine sampling of mid jugular nodes, frozen sections assessed nodal invasion. On the grounds of this policy, 205 patients underwent unilateral or bilateral neck dissection; 17% of them died during follow-up whereas 5.9% (12 cases) exhibited a cervical nodal recurrence, 6 of them occurring less than two years post-operatively, including 3 medullary thyroid carcinomas. 548 had no neck dissection; 9% died during follow-up whereas 0.9% (5 cases) exhibited a cervical nodal recurrence, 3 of them occurring less than two years post-operatively. Routine neck dissection seems not to be justified in the surgery of non medullary differentiated thyroid carcinoma, in as much as late occurrence of cervical node metastases is uncommon and does not obviously impair life-expectancy.

Carcinoma, Papillary↗
PubMed2001

[Sentinel lymph node excision. Treatment method of the N0 neck in patients with oral and oropharyngeal carcinoma].

BACKGROUND: The clinically non-metastatic neck is an unsolved problem in the treatment of oral and oropharyngeal squamous cell carcinomas. A rational procedure is looked for which is neither exaggerated nor neglects the needed safety. PATIENTS AND METHODS: 15 patients with primary squamous cell carcinomas of the oral cavity and the oropharynx, staging T1-4N0M0 were examined. After peritumoral intramucodermal injection of tc99m-labeled colloidal albumin the lymphoscintigraphy using gamma-camera imaging prior and hand-held gamma-probe during operation were used for identification of the nodes. Selective sentinel lymph node exstirpation was followed by radical tumor resection. RESULTS: In all cases (n = 41) lymph nodes could be detected, 40 of them were sentinel lymph nodes, distributed to all neck levels, in 5 cases bilateral drainage. 92.5% of sentinel lymph nodes could be actually removed. All but 1 (97.5%) were true-negative. In the positive case modified radical neck dissection harvested another affected node. CONCLUSIONS: Methodically seen, the sentinel procedure works well and might lead to reduced post-surgical morbidity in about 50% of patients with oral cancer. To date, the procedure should be confined to studies with special requirements to diagnostics and subsequent treatment.

Adult↗