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PubMed2003

Patients with recurrent breast cancer: does the primary axillary lymph node status predict more aggressive tumor progression?

BACKGROUND: The extent of axillary lymph node involvement represents the foremost important prognostic parameter in primary breast cancer, and, thus, is one of the main determinants for subsequent systemic treatment. Nevertheless, the relevance of the initial axillary lymph node status on survival after disease recurrence is discussed controversially. Persisting prognostic impact after relapse would identify lymph node status as a marker for tumor biology, in contrast to a simply time-dependent phenomenon. METHOD: Retrospective analysis of 813 patients with locoregional or distant recurrence of primary breast cancer, who were primarily diagnosed with their disease at the I. Frauenklinik, Ludwig-Maximilians-University, Munich, and the University Hospital in Berlin-Charlottenburg, Germany, between 1963 and 2000. To be eligible, patients were required to have been treated for resectable breast cancer free of distant disease at the time of primary diagnosis, and must have undergone systematic axillary lymph node dissection. Patients with unknown tumor size or nodal status were excluded from the study. All data were gathered contemporaneously and compared with original patients files, as well as the local cancer registry, ensuring high quality of data. The median observation time was 60 (standard deviation 44) months. RESULTS: At time of primary diagnosis, 273 patients (33.6%) were node-negative, while axillary lymph node metastases were detected in 540 patients (66.4%). In univariate analysis tumor size, axillary lymph node status, histopathological grading, hormone receptor status, as well as peritumoral lymphangiosis and haemangiosis carcinomatosa were significantly correlated with survival after relapse (all, P < 0.0001). Kaplan-Meier analysis estimated the median survival time after relapse in node-negative patients to be 42 months (31-52 months, 95% CI), and 20 months in patients with 1-3 axillary lymph node metastases (16-24 months, 95% CI), compared to 13 months in patients with at least 4 involved axillary nodes (12-15 months, 95% CI). Multivariate logistic regression analysis, allowing for tumor size, axillary lymph node status, histopathological grading, presence of lymphangiosis carcinomatosa, relapse site and disease-free interval confirmed all parameters, except of histopathological grading (P = 0.14), as significant, independent risk factors for cancer associated death. Subgroup analyses, accounting for site of relapse and duration of disease-free interval, confirmed primary lymph node status as independent predictor for cancer-associated death after relapse. CONCLUSION: Lymph node involvement at primary diagnosis of breast cancer patients predicts an unfavorable outcome after first recurrence, independently of the site of relapse and disease-free interval. These observations support the hypothesis that primary lymph node involvement is not a merely time-dependent indicator for tumor progression, but indicates tumors with aggressive biological behavior.

Axilla↗

PubMed2004

Impact of microscopic hepatic lymph node involvement on survival after resection of colorectal liver metastasis.

BACKGROUND: Macroscopic hepatic lymph node involvement is usually a contraindication to hepatic resection. Only a few studies have investigated the impact of hepatic lymph node involvement on survival. The aim of this retrospective study was to assess microscopic hepatic lymph node involvement in resectable colorectal liver metastasis and outcomes in patients with such involvement. STUDY DESIGN: From January 1985 to December 2000, 156 patients underwent curative liver resection in association with systematic hepatic lymph node dissection for colorectal liver metastasis. A first analysis was performed to assess the association between hepatic lymph node metastasis and patients' characteristics. A second analysis assessed survival after resection of liver colorectal metastasis by using the Kaplan-Meier method. RESULTS: Twenty-three of the 156 patients (15%) had microscopically involved hepatic lymph nodes. No predictive factor of lymph node metastasis was identified. Multivariate analysis showed that lymph node metastasis, preoperative carcinoembryonic antigen level, number of metastases, and morbidity were factors influencing survival. The 3- and 5-year survival rates of patients with lymph node metastasis were 27% and 5%, respectively, compared with 56% and 43% without lymph node metastasis (p = 0.0001). CONCLUSIONS: During resection of liver colorectal metastasis, microscopic lymph node involvement occurred in 15% of the patients and was associated with a poor 5-year survival. Hepatic lymph node dissection should be performed systematically to select high-risk patients.

Colorectal Neoplasms↗

PubMed1990

[Differential diagnosis of lymph nodes in oral-maxillary regions by ultrasonography].

We divided lymph nodes into three groups, those that are normal, those with lymphadenitis, and those that are metastatic. We analyzed these groups based on their ultrasonographic images by measuring maximum cross-section, L/T ratio, coutour, internal echo images, and posterior echo images, and examined the results statistically. In this study, especially for images relevant to internal echoes, the sound wave reflected from the interior of the lymph nodes was taken as aggregate of bright spots, which were analyzed in terms of the following aspects: texture or size, distribution pattern, and brightness. The results are as follows. (1) The size of the lymph nodes is 7.1 +/- 1.7 mm (mean +/- S.D.) for normal, 10.6 +/- 3.8 mm for lymphadenitis, and 13.1 +/- 7.3 mm for metastatic. (2) The L/T ratio is 0.55 +/- 0.16 for normal, 0.64 +/- 0.21 for lymphadenitis, and 0.83 +/- 0.15 for metastatic. (3) The increment of the lymph node size and the variation in L/T ratio are plotted in the disperation diagram. It was concluded that differential diagnosis would be difficult only based on the size and L/T ratio of the lymph nodes under study. (4) The contour appears indistinct in normal lymph nodes, especially in their lateral aspect, while it is distinct around the whole circumference in lymph nodes with inflammation or metastatic cancer. (5) From the analysis based on texture, distribution, and brightness of the echo images of the interior of lymph nodes, it was concluded that in metastatic lymph nodes, aggregated echoes are distributed unevenly, and their brightness is similar to that of adjacent tissues. 6. Posterior echo images were unique findings that showed acute lymphadenitis. Those analytical results based on the three types of findings were rated and submitted to T-tests, which showed that there is a significant difference at a level of 5% among normal lymph nodes, those with inflammatory changes, and those with metastases.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis, Differential↗

PubMed1990

Carcinoma of the vulva. Clinicopathologic factors involved in inguinal and pelvic lymph node metastasis.

Eighty-five women with vulvar squamous cell carcinoma were subjected to radical vulvectomy with bilateral inguinal and femoral node dissection or to radical vulvectomy with bilateral inguinofemoral and deep pelvic node dissection. The association between lymph node status (metastatic or not) and several parameters was analyzed: tumor location, size and clinical stage; tumor thickness, histologic grade and mitotic index; blood vessel, lymphatic and perineural infiltration; and lymphocytic and plasma cell infiltrates. There were no metastases to the pelvic lymph nodes without previous inguinal lymph node involvement. Unilateral vulvar carcinomas did not have contralateral metastatic nodes when there was no ipsilateral nodal involvement. Lymphatic vessel infiltration showed a statistically significant correlation with inguinal node metastases (P less than .05). No correlation was found between lymph node metastasis and tumor size, clitoral invasion, tumor thickness, histologic grade, blood vessel and perineural infiltration, lymphocytic and plasma cell infiltrates, and mitotic index.

Adult↗

PubMedDate not supplied

[Metastasis in axillary lymph nodes in breast carcinoma--possibilities of mammographic diagnosis].

INTRODUCTION: Enlarged axillary lymph nodes are often found during routine examinations. They are usually circular, oval, lobular, smaller than 1 cm, with typically changed fat centers. The condition of axillary lymph nodes in breast cancer is of great importance for timely diagnosis, because its metastatic spread is a primary prognostic sign of breast cancer. Therefore, the purpose of this paper is to explore possibilities of mammographic diagnosis in detecting enlarged lymph nodes. MATERIAL AND METHODS: The authors present 69 patients with enlarged axillary lymph nodes discovered by clinical examination and mammography of the axila. Of 69 patients, 47 patients had metastatic breast cancer, 21 subject had dysplasia and 1 patient had bacterial infection. Of 47 patients with breast cancer metastases, in 38 the tumour mass in breast was visible by mammography; microcalcifications had been found in 5 patients, while in 4 subjects the tumour mass was not visible either in one, or the other mamma. Biopsy was performed in all 47 patients and diagnosis was confirmed microscopically (by PH). DISCUSSION AND CONCLUSION: The appearance of enlarged lymph nodes in axilla may be a primary clinical and mammographic sign of the earliest breast cancer. The diagnosis is not the problem if lymphadenopathy, together with visible cancer, is present (Figure 1). The problem arises when enlarged lymph nodes are without visible tumour mass in the breast (Figures 2 and 3), because their enlargement can also be seen in dysplasia, inflammation (Fig. 6), lymphoma, metastases of some other tumour (rarely), systemic disease. In all presented patients with metastatic breast cancer, lymph nodes were extremely enlarged, homogeneous and separated. All of them had no hylar fatty degeneration which is a characteristic of benign enlargement of lymph nodes. But, it is impossible to make a differential diagnosis between malignant changes and benign enlargement of lymph nodes by mammography. Consequently, biopsy of all lymph nodes larger than 1 cm, being not infiltrated by fat is suggested (excluding mastitis and dermatitis), because only pathology can give answer to the cause of lymph nodes enlargement.

Axilla↗

PubMed1991

Immunoglobulin-related amyloidosis presenting as recurrent isolated lymph node involvement.

Up to 37% of cases of generalized primary and secondary amyloidosis demonstrate lymph node involvement. Lymph node involvement as the presenting feature of generalized amyloidosis is uncommon. Isolated lymph node amyloidosis (that is, with no extranodal amyloidosis) is exceedingly rare; review of the literature reveals only two reported cases. A case of recurrent isolated lymph node amyloidosis is presented, with review of the literature.

Amyloidosis↗

PubMed2001

Sentinel lymph node biopsy in patients with papillary thyroid carcinoma.

BACKGROUND: It remains controversial whether modified radical neck dissection (MRND) for patients with papillary thyroid carcinoma improves prognosis. However, it is highly probable that the incidence of local recurrence is reduced by lymph node dissection. Sentinel lymph node (SLN) biopsy (SLNB) for patients with melanoma and breast carcinoma has been validated as an accurate method for assessing lymph node status. The objective of this study was to determine the feasibility of SLNB for the evaluation of cervical lymph node status in patients with papillary thyroid carcinoma. METHODS: After injection of methylene blue around the tumor in 22 patients with papillary thyroid carcinoma, blue-stained lymph nodes were dissected as SLNs. After the SLNB, all patients also underwent subtotal thyroidectomy and MRND. SLNs and other lymph nodes were investigated with regard to their number, distribution, size, lymph node status, and ratio of metastatic area. RESULTS: There was concordance between the SLN findings and the regional lymph node status in 19 of 21 patients (90.5%; 7 patients had both positive SLN and regional lymph node results, and 12 patients had both negative SLN and regional lymph node results). Two patients had negative SLN results but, in the end, had positive nonsentinel lymph nodes (NSLNs). The overall reliability rate of SLNB was 86.3% (19 of 22 patients). The authors experienced no complications with the use of methylene blue for the detection of SLNs. CONCLUSIONS: SLNB using methylene blue is feasible technically and is safe, and the findings correlate with cervical lymph node status. Therefore, SLNB is a good technique for estimating the status of cervical lymph nodes in patients with papillary thyroid carcinoma.

Adult↗

PubMed1992

[Angiofollicular lymph node hyperplasia (Castleman disease)].

Angiofollicular lymph node hyperplasia (Castleman's disease) is a relatively rare disease of differential diagnostic interest in patients with lymphadenopathy. The etiology and pathogenesis are still not elucidated. The disease is classified into localized and systemic types. The localized form is divided histologically into hyaline-vascular type and plasma cell types. The former is usually demonstrated incidentally as a widening of the mediastinum in otherwise asymptomatic patients. The plasma cell type usually presents in the abdominal lymph nodes and is accompanied by fever, loss of weight, anemia and hypergammaglobulinemia. Surgical treatment is curative in the localized disease. The systemic disease involves multiple lymph nodes, and multiple organs are affected. The prognosis is dubious, and frequently the patients rapidly die from septicemia or other infectious complications. Some patients develop malignancies. Treatment with glucocorticosteroids and chemotherapy has only demonstrated a limited effect. The diagnosis requires both a characteristic histopathology and typical clinical symptoms. A current illustrative case report is presented.

Castleman Disease↗

PubMed2004

Lymphoscintigraphic and intraoperative detection of the sentinel lymph node in breast cancer patients: the nuclear medicine perspective.

The concept of sentinel lymph node biopsy in breast cancer surgery relates to the fact that the tumor drains in a logical way via the lymphatic system, from the first to upper levels. Therefore, (1) the first lymph node met (the sentinel node) will most likely be the first one affected by metastasis, and (2) a negative sentinel node makes it highly unlikely that other nodes are affected. Sentinel lymph node biopsy would represent a significant advantage as a mini-invasive procedure, considering that, after operation, about 70% of patients are found to be free from metastatic disease, yet axillary node dissection can lead to significant morbidity. Although the pattern of lymphatic drainage from a breast cancer can be very variable, the mammary gland and the overlying skin can be considered as a biologic unit in which lymphatics tend to follow the vasculature. Considering that tumor lymphatics are disorganized and relatively ineffective, subdermal, and peritumoral injection of small aliquots of radiotracer is preferred to intratumoral administration. (99m)Tc-labeled colloids with most of the particles in the 100-200 nm size range would be ideal for radioguided sentinel node biopsy in breast cancer. Lymphoscintigraphy is an essential part of radioguided sentinel lymph node biopsy, as images are used to direct the surgeon to the site of the node. The sentinel lymph node should have a significantly higher count than background. After removal of the sentinel node, the axilla must be re-examined to ensure all radioactive sites are identified and removed for analysis. The success rate of radioguidance in localizing the sentinel lymph node in breast cancer surgery is about 94-97% in Institutions where a high number of procedures are performed, approaching 99% when combined with the vital blue dye technique. At present, there is no definite evidence that a negative sentinel lymph node biopsy is invariably correlated with a negative axillary status, except perhaps for T(1a-b) breast cancers, with size < or =1 cm. Randomized clinical trials should elucidate the impact of avoiding axillary node dissection in patients with a negative sentinel lymph node on the long-term clinical outcome of patients.

Breast Neoplasms↗

PubMed1991

[A comparative study of weight of regional lymph nodes in association with the presence of metastasis in primary lung cancer patients].

The weight of regional lymph nodes was measured in 173 patients who underwent surgical resection of the primary lung cancer and lymph nodes from January, 1986 to January, 1989 in our hospital. Histological examination was also performed and correlation of metastasis and the weight of lymph nodes were studied. The average weight of metastatic lymph nodes was 2.34 g while that of non-metastatic ones was 0.83 g indicating a significant (p less than 0.05) increase of weight in metastatic lymph nodes. Although the percentage of metastasis increased as the weight of lymph nodes increased, 7.6% of lymph nodes weighing less than 0.5 g was positive for metastasis. On the other hand, 66.7% of the lymph nodes weighing more than 3.0 g in adenocarcinoma and 34.5% in squamous cell carcinoma were positive for metastasis indicating the difference of the metastatic tendency to the lymph nodes between the two histological types. The comparative study of the weight of each lymph node station according to the JJC criteria demonstrated the difference of average weight of non-metastatic lymph nodes among each lymph node station. The average weight of pretracheal (#3), subcarinal (#7), interlobar (#11), and segmental (#12) lymph nodes without tumor metastasis were more than 1.0 g, however those of anterior mediastinal (#3a), paraesophageal (#8), and pulmonary ligament (#9) were less than 0.5 g. The average weight of metastatic lymph nodes in each lymph node station was in proportion to those of non-metastatic ones.

Adenocarcinoma↗

PubMed2000

Nodal basin recurrence following lymph node dissection for melanoma: implications for adjuvant radiotherapy.

PURPOSE: To analyze patterns of failure in malignant melanoma patients with lymph node involvement who underwent complete lymph node dissection (LND) of the nodal basin. To determine prognostic factors predictive of local recurrence in the lymph node basin in order to select patients who may benefit from adjuvant radiotherapy. METHODS AND MATERIALS: A retrospective analysis of 338 patients undergoing complete LND for melanoma between 1970 and 1996 who had pathologically involved lymph nodes was performed. Mean follow-up from the time of LND was 54 months (range: 12-306 months). Lymph node basins dissected included the neck (56 patients), axilla (160 patients), and groin (122 patients). Two hundred fifty-three patients (75%) underwent therapeutic LND for clinically involved nodes, while 85 patients (25%) had elective dissections. Forty-four percent of patients received adjuvant systemic therapy. No patients received adjuvant radiotherapy to the lymph node basin. RESULTS: Overall and disease-specific survival for all patients at 10 years was 30% and 36%, respectively. Overall nodal basin recurrence was 30% at 10 years. Mean time to nodal basin recurrence was 12 months (range: 2-78 months). Site of nodal involvement was prognostic with 43%, 28%, and 23% nodal basin recurrence at 10 years with cervical, axillary, and inguinal involvement, respectively (p = 0.008). Extracapsular extension (ECE) led to a 10-year nodal basin failure rate of 63% vs. 23% without ECE (p < 0.0001). Patients undergoing a therapeutic dissection for clinically involved nodes had a 36% failure rate in the nodal basin at 10 years, compared to 16% for patients found to have involved nodes after elective dissection (p = 0.002). Lymph nodes larger than 6 cm led to a failure rate of 80% compared to 42% for nodes 3-6 cm and 24% for nodes less than 3 cm (p < 0.001). The number of lymph nodes involved also predicted for nodal basin failure with 25%, 46%, and 63% failure rates at 10 years for 1-3, 4-10, and > 10 nodes involved (p = 0.0001). There was no significant difference in nodal basin control in patients with synchronous or metachronous lymph node metastases, nor in patients receiving or not receiving adjuvant systemic therapy. Nodal basin failure was predictive of distant metastasis with 87% of patients with nodal basin recurrence developing distant disease compared to 54% of patients without nodal failure (p < 0.0001). On multivariate analysis, number of positive nodes and type of dissection (elective vs. therapeutic) were significant predictors of overall and disease-specific survival. Size of the largest lymph node was also predictive of disease-specific survival. Site of nodal involvement and ECE were significant predictors of nodal basin failure. CONCLUSIONS: Malignant melanoma patients with nodal involvement have a significant risk of nodal basin failure after LND if they have cervical involvement, ECE, >3 positive lymph nodes, clinically involved nodes, or any node larger than 3 cm. Patients with these risk factors should be considered for adjuvant radiotherapy to the lymph node basin to reduce the incidence of nodal basin recurrence. Patients with nodal basin failure are at higher risk of developing distant metastases.

Adult↗

PubMed1980

Lymphocyte traffic through lymph nodes during cell shutdown.

Antigenic challenge of lymph nodes in sheep has marked effects on lymphocyte traffic through lymph nodes. The non-specific effects include a marked reduction in lymphocyte output in efferent lymph without a corresponding decrease in lymph flow--a phenomenon known as cell shutdown. With certain antigens there is a total disappearance of B lymphocytes during cell shutdown. The phenomenon can be reproduced in unprimed lymph nodes whenever localized complement activation occurs within the node. This also induces the release of prostaglandins, particularly PGE2. These results suggest that cell shutdown might be a two-step process involving both complement and prostaglandins. Repeated stimulation of nodes with antigen also has considerable effects on the traffic of antigen-specific lymphocytes. Antigen localized within the node can promote the selective entry into the node of T lymphocytes specific for the challenge antigen. Consequently there is a net loss from the whole animal of T cells reactive to the challenge antigen. These results are discussed in relation to lymphocyte recirculation through antigen-stimulated lymph nodes.

Animals↗

PubMed1992

Anatomy and biopsy of sentinel lymph nodes.

Lymphangiograms performed via the dorsal lymphatics of the penis demonstrate drainage into a specific lymph node center, the so-called sentinel lymph node, which is located close to the superficial epigastric vein between the latter and the superficial external pudendal vein. Anatomically, clinically, and pathologically, the sentinel lymph node is the first site of metastasis and often is the only lymph node involved. We recommend preliminary bilateral sentinel lymph node biopsy, with inguinofemoral dissection being performed only when this node is involved. If the biopsies are negative for metastases, no further surgical therapy is immediately indicated, and the patient needs to be observed closely with monthly examination for 1 year and examination every 2 months for 3 years. The clinical staging of cancer of the penis needs a new review for further evaluation of different modalities of treatment. Sentinel lymph node biopsy must not be used to determine whether node dissection is needed in patients with evident clinically positive nodes. Also, the concept of sentinel lymph node should not be applied in the management of patients who will not be available for frequent follow-up. If during physical examination, suspect lymph nodes are found other than the classic sentinel node, these lymph nodes must be removed for staging and subsequent treatment planned according to the histologic report.

Biopsy↗

PubMed1978

The histogenesis of lymph nodes in rat and rabbit.

The histogenesis of the popliteal lymph node in the rat and the popliteal and inguinal lymph nodes in the rabbit was examined by light microscopy. Special emphasis has been laid on the initial lymphocyte population in the lymph node anlage. In the rat on the seventeenth day of gestation lymphoid cells populate a limited mesenchymal area along the vein wall. The next day the mesenchyme shows a bulb-shaped outgrowth causing an indentation in the wall of a lymph vessel, running parallel to the vein and having a saccular widening at this place. The bulb-shaped lymphoid outgrowth fills up the widened lymph vessel; the subcapsular sinus originates from the remaining parts of the lymph vessel. At birth the lymph node can be divided into a primitive cortex consisting of an area with evenly scattered lymphocytes among the basic network of reticular cells and a medulla. About three days after birth an ovoid area containing a dense concentration of lymphocytes is observed in the inner cortex. In the next days it expands in both lateral and medullary direction but not into the outer cortex. Primary follicles appear in the outer cortex 18 days after birth. The development of the inguinal and popliteal lymph nodes in the rabbit shows the same characteristics as the histogenesis of the popliteal lymph node in the rat. The morphogenesis of the lymph node is summarized in a schematic diagram.

Animals↗

PubMed2004

Prediction of mediastinal lymph node metastasis in medullary thyroid carcinoma.

BACKGROUND: Mediastinal lymph node metastases can be life threatening owing to their proximity to vital organs. Reliable identification of mediastinal metastasis is of utmost importance for timely mediastinal lymph node dissection, although suitable clinicopathological variables for their detection in patients with thyroid cancer have yet to be identified. METHODS: This was an analysis of 83 consecutive patients with radiological suspicion of mediastinal metastasis who underwent trans-sternal mediastinal lymph node dissection for node-positive medullary thyroid carcinoma between November 1994 and March 2003. RESULTS: Univariate analysis revealed that extrathyroidal extension (P < 0.001), distant metastasis (P = 0.001), the preoperative serum calcitonin level (P = 0.001), operation type (P = 0.004), contralateral cervicolateral metastasis (P = 0.016) and bilateral nodal metastasis (P = 0.031) were significantly associated with mediastinal involvement. Only extrathyroidal extension remained significant in a multivariate logistic regression analysis of mediastinal lymph node metastasis. Prediction of mediastinal metastasis by extrathyroidal extension was best at reoperation, with a specificity of 97 per cent and a positive predictive value of 88 per cent. CONCLUSION: Mediastinal lymph node dissection should be considered in patients undergoing reoperation for node-positive medullary thyroid carcinoma who have extrathyroidal extension and cervical lymph node metastases.

Adult↗

PubMed2001

Pattern of lymph node micrometastasis and prognosis of patients with colorectal cancer.

BACKGROUND: Studies of lymph node micrometastases in patients with colorectal cancer have ignored the prognostic significance of the number and level of lymph node micrometastases. The aim of this study was to clarify the prognostic significance of the status of lymph node micrometastases in histologically node-negative colorectal cancer. METHODS: We used immunohistochemistry with anti-cytokeratin antibody CAM5.2 to examine 1013 lymph nodes in 42 patients (12 recurrent and 30 nonrecurrent) with histologically determined Dukes' B colorectal cancer. Five serial 6-microm sections were used for immunohistochemical staining. The frequency, tumor cell pattern, and number and level of lymph node micrometastases were compared between the recurrent and nonrecurrent groups. RESULTS: Micrometastasis was confirmed in 16% (59/373) of lymph nodes in the recurrent group and 12% (77/640) of lymph nodes in the nonrecurrent group, and the frequency of lymph node micrometastases was 92% (11/12) in the recurrent group and 70% (21/30) in the nonrecurrent group. The tumor cell pattern in the metastatic lymph nodes was similar in the recurrent and nonrecurrent groups. Micrometastasis in four or more lymph nodes occurred more frequently in the recurrent group than in the nonrecurrent group (58% vs. 20%, P < .05), and micrometastasis to N2 or higher nodes occurred more frequently in the recurrent group than in the nonrecurrent group (92% vs. 47%, P < .01). CONCLUSIONS: The number and level of positive micrometastatic lymph nodes was significantly correlated with postoperative recurrence of histologically determined Dukes' B colorectal cancer. This parameter is a useful prognostic indicator in histologically node-negative colorectal cancer and is helpful in planning adjuvant chemotherapy.

Aged↗

PubMed1995

Is pancreatoduodenectomy justified for periampullary cancers with regional lymph node involvement?

Justification of pancreatoduodenectomy for highly malignant periampullary cancers with regional lymph node involvement is questioned. Attempting to clarify the therapeutic dilemma, we compared the prognoses of resectable periampullary cancers with and without lymph node involvement, as well as unresectable cancers with lymph node involvement. The medical records of surgical patients with periampullary adenocarcinoma were reviewed. We compared the survival times of resectable cancers with (resectable TanyN1M0) and without (resectable TanyN0M0) regional lymph node involvement, and the survival times of resectable cancers with lymph node involvement (resectable TanyN1M0) and unresectable cancers with lymph node involvement (unresectable TanyN1M0). There were 138 resectable and 115 unresectable periampullary cancers including 117 cancers of the pancreatic head, 117 cancers of ampulla of Vater, 7 cancers of duodenum, and 12 cancers of distal common bile duct. The prognosis was very poor in cancer of the pancreatic head. Neither resectability nor status of lymph node involvement could influence the survival time of the cancer of pancreatic head. In resectable non-pancreatic periampullary cancers, the prognosis was significantly better in the group without lymph node involvement. However, once the lymph node was involved, the outcomes were the same in the resectable and unresectable groups. Although pancreatoduodenectomy does not seem to be justified for periampullary cancers with regional lymph node involvement, this procedure should be considered for periampullary cancers without nodal involvement.

Adenocarcinoma↗

PubMed1994

Comparative financial analysis of laparoscopic versus open pelvic lymph node dissection for men with cancer of the prostate.

Laparoscopic pelvic lymph node dissection has been applied as a minimally invasive staging technique for men with prostate cancer. This procedure has been shown to shorten markedly postoperative hospitalization, decrease analgesic requirements and shorten convalescence period compared to open pelvic node dissection. However, the laparoscopic procedure takes longer to perform and many disposable instruments are used, thus increasing the cost. We determine the overall cost of laparoscopic versus open pelvic lymph node dissection. Between January 1989 and April 1992, 61 men underwent only staging pelvic lymph node dissection for cancer of the prostate at a single university teaching hospital. Of these patients 11 and 50 underwent open and laparoscopic pelvic lymph node dissection, respectively. Information from the hospital business office was reorganized into preoperative, intraoperative and postoperative expenses. All individual charges were transformed up or down to the dollar amounts of the 1990 to 1991 fiscal year so as to correct for inflationary changes. Preoperative costs were not significantly different between the 2 operative approaches. Intraoperative expenses were 52% greater if laparoscopic pelvic lymph node dissection was performed and can be explained by the longer operative times and use of disposable instrumentation. However, the postoperative period lasted an average of 1.61 days following laparoscopic pelvic lymph node dissection. Postoperative nursing and analgesic requirements were significantly more for patients undergoing open pelvic lymph node dissection. The overall postoperative costs following open pelvic lymph node dissection were 280% more expensive than for the laparoscopic procedure. The overall total costs were approximately $1,250 more for laparoscopic pelvic lymph node dissection. Wages lost or earned during this period and rapid return to normal activity following laparoscopic pelvic lymph node dissection would, in our opinion, justify this additional cost.

Aged↗