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Pelvic lymphadenectomy for stage B1 adenocarcinoma or the prostate: justified or not?

Of 47 consecutive patients who had undergone staging pelvic lymphadenectomy for clinically localized adenocarcinoma of the prostate 26 had clinical stage B1 disease. Only 2 of these patients (8 per cent) had positive pelvic nodes. The low incidence of lymphatic spread, the potential complications of lymphadenectomy and the role of regional lymphatics in generating an immunological defense raise the question of the efficacy of lymphadenectomy in the treatment of rigidly defined, clinical stage B1 adenocarcinoma of the prostate.

Adenocarcinoma

Experience in staging testis tumors with bleomycin 57cobalt and present role of 67gallium scan.

A technique was developed using bleomycin and 57cobalt to study nodal metastases in testis tumors. Comparative studies were made on 15 cases with 67gallium, lymphangiography, supraclavicular node biopsy, liver and spleen scans, chest x-ray, excretory urogram, bone survey and pathological study of surgical specimens when possible. The results with the bleomycin-57cobalt complex and 67gallium were discouraging. The bleomycin-57cobalt study was discontinued. Pathological staging is still the most accurate of all modalities available for staging testicular malignancies.

Biopsy

[A rare clinical manifestation of a combination tumor of cystosarcoma phylloides malignum and an intraductal cancer].

A combination of cystosarcoma phylloides and ductal carcinoma in the breast of a 47-year old woman is reported. Only few cases of this simultaneous tumour formation is described in the literature. Therapy, prognosis and follow-up are discussed. Current standard therapy is ablatio mammae, modified according to Patey, with axillary lymphnode dissection. Decision in respect of chemotherapy depends on the results of staging. Follow-up control of the patients for early detection and therapy of metastasis is recommended. The reported case underlines, that histological examination of every breast node is indicated, even if there is no sign of malignancy.

Breast

[Follow-up of 551 patients with node-negative breast cancer].

To evaluate the prognostic significance of established clinical, histological, and biochemical factors, we examined the survival data of 551 node-negative breast cancer patients. At a median follow-up of 5 years, we found 114 recurrences, 79 of them at distant sites. 41 patients died. 84 patients with less than 8 examined lymph nodes, adjuvant systemic treatment, or treatment differing from standard procedures, had a statistically significant shorter overall survival and were excluded from further analysis. With regard to relapse-free and overall survival univariate and multivariate analyses of the remaining 467 patients revealed only few factors with prognostic significance. In multivariate analysis of overall survival by the Cox regression model, statistically significant prognostic value was limited to three factors: lymphangiosis carcinomatosa (relative risk 4.8, 95%-confidence interval 2.0-11.7), postmenopausal status (0.38, 0.17-0.84), and positive progesterone receptor status (0.37, 0.14-1.0). In addition, there was a trend (p = 0.075) of prolonged survival in patients with Bloom and Richardson grade I cancers. The few prognostic factors found were able to identify patients with very good, as well as very bad prognosis. However, for the majority of node-negative breast cancer patients, estimation of prognosis remains unsatisfactory. Therefore, further independent prognostic factors are necessary.

Actuarial Analysis

[Recurrence of vulvar cancer--treatment, experiences and results].

At the University Hospitals of Heidelberg (1970-1988) and Homburg/Saar (1988-1990), 182 patients with vulvar carcinoma were treated. 51 patients had a recurrence of vulvar carcinoma and 21 patients showed a persistence of this tumour. 19 women had a second recurrence of vulvar disease. In these cases, therapy ranged from local surgery to exenteration, depending on the site and tumour extension. 18 patients underwent successful reconstructive surgery. Prognosis was better in cases with local recurrence in comparison to distant sites of metastatic progression (i.e. inguinal nodes or disseminated disease) (p less than 0.001). The five-year survival (after diagnosis of recurrent disease) for patients with early onset of recurrence (less than 20 months after initial therapy) was 28% compared to 68% for patients with late onset of recurrent disease (p less than 0.01).

Female

Splenic hilum nodal involvement in resected left-sided pancreatic cancer: meta-analysis.

BACKGROUND: Splenectomy is standard of care during left pancreatectomy for pancreatic ductal adenocarcinoma (PDAC) to obtain adequate lymphadenectomy. However, evidence supporting this approach is lacking. Splenic preservation would reduce short-term morbidity and is essential for emerging oncological adjunctive therapies, including immunotherapy and personalized cancer vaccines. This study reviewed the incidence of splenic hilum nodal involvement (SHNI) in left-sided PDAC. METHODS: A systematic review of the PubMed, Embase, and Cochrane databases was performed, identifying studies published from inception to July 2026. Outcomes of interest were the rate of SHNI (station 10), overall survival, and the rate of splenic artery nodal involvement (SANI; station 11). Meta-analyses were conducted using random-effects models. Subgroup analyses for SHNI were performed per tumour localization (pancreatic neck, body, tail). RESULTS: Among 2776 screened studies, 22 with 2260 patients undergoing left pancreatectomy for PDAC were included. The pooled prevalence of SHNI was 3.7% (95% confidence interval (c.i.) 2.2% to 6.2%); 1.1% for pancreatic body PDAC (95% c.i. 0.3% to 4.3%) and 9.7% for pancreatic tail PDAC (95% c.i. 3.5% to 24.0%). SHNI was not significantly associated with survival (pooled hazard ratio 2.05; 95% c.i. 0.89% to 4.72; P = 0.072). The pooled prevalence of SANI was 39.1% (95% c.i. 25.1% to 55.1%). CONCLUSION: In patients undergoing left pancreatectomy for PDAC, the presence of SHNI is rare, particularly in pancreatic body cancer (1.1%). These findings suggest that the relevance of routine splenectomy remains unclear, especially for pancreatic body PDAC. However, because the quality of current evidence is low, further investigation in prospective studies is required.

Humans

Staging laparotomy in the treatment of metastatic melanoma of the lower extremities.

Twenty-six consecutive patients with melanoma of the lower extremities metastatic to the superficial inguinal lymph nodes were subjected to laparotomy. No patient had preoperative evidence of tumor dissemination past the superficial inguinal nodes. However three patients (12%) had metastases to the liver or para-aortic lymph nodes documented at laparotomy and were not subjected to iliac and obturator lymph node dissection. One of these patients had concomitant local recurrence of melanoma at the ankle. The other two patients had superficial inguinal lymph nodes at least 5 cm in diameter, although two other such patients with similar 5 cm lymph nodes did not have positive intra-abdominal findings. The remaining 23 of the 26 patients underwent ipsilateral iliac and obturator lymph node dissection, which proved positive in 3/23 patients (13%). Of these 23 patients undergoing iliac and obturator node dissection, 18 had clinically positive (and microscopically positive) superficial inguinal nodes prior to their dissection, while the remaining 5 patients had clinically negative (but microscopically positive) superficial inguinal nodes. The three cases of positive dissected iliac and obturator nodes occurred among the 18 patients with clinically positive superficial inguinal nodes (17%). Among the 5 patients with clinically negative, microscopically positive superficial groin nodes, there was no detectable deep inguinal nodal spread (or hepatic or para-aortic involvement).

Adolescent

Prognostic factors in patients undergoing lymphadenectomy for malignant melanoma.

Review of a 19 year experience in melanoma patients undergoinglymphadenectomy at the National Cancer Institute revealedthat the preoperative assessment of the status of theregional lymph nodes was accurate 91% of the time when thesurgeon felt the nodes were clinically positive, and accurate79% of the time when the nodes were judged clinically negative. The 10-year survival in patients with one to three histologicallypositive nodes or no positive nodes was 50-55%, compared to a25% 8-year survival in patients with four or more histologicallypositive nodes. Stepwise multivariate evaluation of prognosticfactors indicated that the most important factor for predictingprognosis is the number of nodes histologically involved. Nodepalpability was the second most important factor because of itshigh correlation with number of nodes histologically involved. Site of melanoma was the third most important factor, aspatients with extremity (upper or lower) melanoma had a bettersurvival (P = 0.002) than patients with axial melanoma (trunkor head and neck). Five years following lymphadenectomythere appeared to be substantial differences in survivalaccording to differences in the level of invasion of the primarylesion, however, these differences were not nearly aspronounced 10 years following node dissection.B The division of melanoma thicknesses into <1.50 mm and>1.50 mm provided some prognostic discrimination at fiveyears but again the differences were not pronounced 10 yearsfollowing node dissection. The thickness measurements wereeasier to determine than the level of invasion, and more reproduceableon resubmission to the same pathologist. Fourpatients with melanoma less than 0.76 mm had subsequentmetastases, but these may represent inadequate sampling of theprimary melanoma both in our series and in the four similarpatients previously reported with such thin metastasizingmelanomas.

Female

Complete reversibility of paraneoplastic acanthosis nigricans after operation.

A patient with widespread acanthosis nigricans is described. No abdominal tumour was found. Explorative thoracotomy disclosed numerous enlarged lymph glands containing squamous cell carcinoma. The left lung was removed but meticulous search did not disclose any tumour. The glands were removed as radically as possible. After the operation the skin improved and the lesions have disappeared completely. The observation time is over three years.

Acanthosis Nigricans

Secondary malignant melanoma in lymph nodes: incidence, time of occurrence, and mortality.

During a follow-up period of six to 12 years, 15.4% of patients in the Queensland Melanoma Project (Q.M.P.) developed histologically proven secondary deposits in lymph nodes. The incidence rate in males (21%) was twice that in females (11%), but the mortality rate was similar (M., 67%; F., 61%). Thirty-two patients (2%) had positive nodes with no known primary lesion. Metastases developed in males with lesions on the foot (50%), on the thigh (29%), and on the back (22%); and in females with lesions on the lower leg (9%) and thigh (20%). About one-half of the nodes were removed at the time of treatment of the primary growth or within two months. Three-quarters were removed in the first year. However, it was found that tumour could remain dormant for more than eight years. Dormant tumours behaved in a similar aggressive fashion on regrowth as non-dormant secondaries. Nodal metastases were present in 5% of patients at the time of their first presentation with primary melanoma. Elective node dissections were done in 6% of males and 11% of females.

Adolescent

Laparoscopic pelvic lymph node dissection.

The infiltration of pelvic lymph nodes by carcinoma of the prostate or carcinoma of the bladder is an important factor in disease staging. Until now, this could be accurately assessed only by means of open surgery, an undesirable option as an investigation. Recent advances in laparoscopic instruments and camera systems have allowed the performance of laparoscopic pelvic lymph node dissection. A series of dissections in 14 patients is reported.

Aged

Influence of surgical manipulations on hexobarbital effects in rats.

In rats the hexobarbital metabolism is impaired after different surgical procedures leading to muscle damage. This leads to a prolongation of the hexobarbital action. The prolonged effect of hexobarbital in rats with lymphostatic encephalopathy is considered an unspecific consequence of the tissue damage during lymphectomy.

Anesthesia, General

Neck dissection: radical or conservative.

Four hundred and forty-five neck dissections for epidermoid carcinoma over a 10-year period are reviewed as to local recurrence of neck disease. Three hundred and forty-seven dissections were radical en bloc procedures and in 98 a modified conservative technique was utilized. Cervical lymph node classification was applied and a comparison made of the two techniques. A review of the anatomy of cervical fascias and the technique of conservative neck dissection is given. Evaluation of this series of cases indicate that the control of local disease in the neck in the N0 and N1 groups is is accomplished as well with conservative dissection as with radical neck dissection. The number of conservative neck dissections for N2 disease was too limited for accurate comparison. There were no conservative neck dissections done for N3 disease. We suggest that conservative neck dissection be utilized for subclinical and N1 disease and that the classic en bloc dissection be reserved for N2 and N3 situations.

Carcinoma, Squamous Cell