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PubMed2003

[Interest of the cervical gland dissection after radiotherapy with or without chemotherapy].

OBJECTIVES: The aim of this study was to evaluate the necessity and morbidity of neck dissection after radiation therapy within organ preservation treatment. PATIENTS AND METHODS: We present a retrospective study of 64 patients, treated initially by radiotherapy with or without chemotherapy for squamous cell carcinoma of head and neck with cervical metastases (> 2 cm), who underwent post-radiation neck dissection between January 1992 and August 2000. Eight (13%) patients were classified T1, nineteen (30%) T2, twenty (31%) T3, eleven (17%) T4 and six (9%) Tx. Eleven patients had N1 neck disease (17%), fifteen patients N2a (24%), eleven patients N2b (17%) and twenty-seven patients N3 (42%). RESULTS: Follow-up ranged from 3 to 86 months with a mean of 39 months. The average length of time between neck dissection and the end of treatment was 60 days. Complications were recorded in 21 patients (33%). Forty-four (68%) of 64 patients had microscopic residual disease. Eight (72%) of 11 patients with N1 neck disease and 17 (63%) of 27 patients with N3 neck disease had pathology. Initial N status was not a predictive factor of microscopic residual disease (p = 0.51). There was no significant relationship between clinical residual adenopathy and microscopic residual disease (p = 0.53). Fourteen patients are still alive without recurrent disease. Eight (57%) of these 14 patients had a positive pathology at the time of neck dissection. The mean follow-up time of these patients is 32.6 months, with a follow up longer than 2 years for half of them (n = 7). CONCLUSION: Neck dissection after radiation was planned for all patients with an initial node > 2 cm in diameter regardless of clinical response in the neck. We confirm that neck dissection appears to be safe after radiotherapy and is necessary because it improves quality of life and prevents fatal evolution with uncontrollable neck disease.

Adult↗

PubMed1992

Successful surgical correction of acute ascending aortic dissection: a case report.

The prognosis of patients with acute aortic dissection is extremely poor, especially when involving the ascending aorta. It has long been recognized as a catastrophic cardiovascular event. Acute dissections involving an ascending aorta have approximately a 90 percent acute mortality rate if left untreated or treated medically. Therefore, nearly all patients with acute ascending aortic dissection should be surgically treated immediately after a diagnosis has been established. A 60-year-old man having an acute ascending aortic dissection was successfully operated on with a resection of the dissecting aorta which was replaced with a Dacron graft. The postoperative course was complicated with a respiratory insufficiency and a disruption of the sternal wound. A 4 years follow-up confirmed the patient was in good condition. This is the first successfully operated case of acute ascending aortic dissection at our hospital.

Acute Disease↗

PubMed2005

[Limited surgery for early gastric cancer using lymphatic basin dissection--a sure method of sentinel node biopsy for gastric cancer].

The results of our sentinel node biopsy for early-stage gastric cancer had a high predictive value for nodal metastasis, with a sensitivity of 85% (34/40) and an accuracy of 98% (259/265). Therefore, sentinel node biopsy is expected to be decided as an adaptation of limited surgery for early gastric cancer. However, there were two serious problems in sentinel node biopsy for gastric cancer; one was the great difficulty of sentinel node detection and biopsy in the operative field, and the other was the possibility of false negative cases in the frozen section diagnosis. To solve these problems, we developed lymphatic basin dissection, a new technique suitable for sentinel node biopsy of gastric cancer. The lymphatic basin is an own lymphatic components dyed in blue in the dye method. In the lymphatic basin dissection method, sentinel nodes are detected and harvested at the back table after en bloc dissection of the lymphatic basins. Lymphatic basin dissection is an excellent method because of the certainty in sentinel node biopsy, and the sure back-up dissection. Lymphatic basin dissection and following limited surgery was performed on 143 patients for early-stage gastric cancer in our hospital. No patient had a recurrence of gastric cancer; 9 patients died of other diseases, and the other 134 survived.

Gastrectomy↗

PubMedDate not supplied

Iatrogenic dissection of the right coronary artery and the ascending aorta secondary to endoluminal angioplasty. A case report.

The authors present the case of a 54-year-old woman with iatrogenic dissection of the right coronary artery ostium and extension of the dissection to the ascending aorta during the intraluminal angioplasty of an obstructive lesion in the middle portion of the right coronary artery. In order to maintain coronary blood flow before surgery, the coronary dissection was treated with the implantation of three direct coronary stents that dilated the stenosis and sealed the dissection of the coronary artery. The aortic dissection needed treatment with the implantation of a Haenoshield aortic graft. During the surgery, it was decided to implant an aortocoronary bypass graft to guarantee the distal right coronary blood flow, given the possible increased risk of thrombosis of the stents because of the large thrombogenic metallic surface of the stents. On the other hand, the administration of anticoagulants and antithrombotic drugs were not indicated because of the intended surgery of the aortic dissection. The evolution of the patient was satisfactory. Causes, frequency, and treatment procedures of this iatrogeny are discussed.

Angioplasty, Balloon, Coronary↗

PubMed1992

[Natural history of a bilateral carotid dissection].

The coexistence of arterial dissection in several cervical vessels is exceptional and is usually an accidental finding detected upon performance of an extensive angiographic examination in patients with unilateral manifestations. The absence of previous clinical manifestations related with asymptomatic vessel dissection impedes the knowledge of the time between the different dissections. The case of a bilateral carotid dissection (CD) is presented in which the clinical course permitted the authors to know the interval between both dissections. The patients initially presented manifestations of right CD and, at 15 days, an ictus due to left CD in which the presence of right unilateral asterixis was of note. The time span between both dissections was established as 12-15 days.

Adult↗

PubMed2006

Omission of mediastinal lymph node dissection in lung cancer: its techniques and diagnostic procedures.

To reduce or omit a mediastinal lymph node dissection in the patients with clinical stage I non-small cell lung cancer (NSCLC), several authors examined the prevalence of metastatic sites of lymph nodes. Because lymphatic drainage usually heads for the upper mediastinum in upper lobe cancer and for the lower mediastinum in lower lobe cancer, upper and lower mediastinal lymph node dissection could be reduced in lung cancers of lower lobe and upper lobe. By using sentinel node (SN) navigation surgery, it is possible to omit mediastinal lymph node dissection. Radiological findings are also useful to determine reduction of mediastinal lymph node dissection. In clinical stage Ia adenocarcinomas that show ground glass opacity (GGO) findings on computed tomography (CT) or negative for fluorodeoxyglucose accumulation on positron emission tomography (PET), mediastinal lymph node dissection can be omitted, because these types of adenocarcinomas rarely metastasize to the lymph nodes. By using these procedures, mediastinal lymph node dissection can be reduced or omitted with little risk of local recurrence.

Carcinoma, Non-Small-Cell Lung↗

PubMed1990

[Study of para-aortic lymph node metastasis of gastric cancer subjected to superextensive lymph node dissection].

Para-aortic lymph nodes (n4), were dissected out to the technical extreme (superextensive lymph node dissection) from 129 gastric cancer cases, and were subjected to the histological study for metastasis. Following observations led us to the conclusions in reference to the significance of n4 node dissections on curability of surgery. 1) Among 25 cases with n4(+) metastasis n3 was free [n3(-)] in 11 cases (44.0%). 2) ps(+) cancer presented high rate of n4(+) (31.5%). 3) n4(+) occurred irrespective of the location of the cancer, with particularly high rate of occurrence among CMA and cancers. 4) The rate of the metastasized lymph nodes to the total number of the n4 lymph nodes, was found low (34.9%) in cases with n3(-), and high (90.1%) with n3(+). 5) The cumulative survival rate of the cases with n4(+) was found significantly high with n3(-), as compared to n3(+) cases. The lymphatic drainage from the stomach seems more direct and/or more abundant to the n4 than to the n3 nodes. Such observation coincides with our experience that the n4 nodes are involved in metastasis in earlier timing and in higher incidence than n3 nodes. These results warn the present evaluation of curability in which the n4 node dissection is not performed. It is our opinion that the thorough dissection extended to the n4 nodes (superextensive lymph node dissection) is warranted, particularly in order to improve the curability of n3(-)-n4(+) cases.

Aorta, Abdominal↗

PubMed1989

[Clinical evaluation of systematic lymph node dissection for the intrathoracic esophageal carcinoma].

We evaluated the effectiveness and complication of systematic lymph node dissection for the intrathoracic esophageal carcinoma, which includes cervical, intrathoracic and abdominal lymph node dissection. Two hundred and thirteen individuals with intrathoracic esophageal carcinoma underwent esophageal resection in the Department of Surgery II, Kyushu University from 1979 to 1988. Of these 213, systematic lymph node dissection in addition to esophageal resection was performed on 19 patients. Lymph node recurrence has been reduced with this procedure and survival rate was more favorable in the cases with systematic lymph node dissection than those without it at present. On the other hand, although the occurrence of postoperative recurrent nerve palsy in the cases with systematic lymph node dissection and in those without it were 47.4 and 11.9%, rates of postoperative pulmonary complications were 5.2 and 16.0%, respectively. Operative death was none in those with systematic lymph node dissection. Therefore, this procedure has been performed in safety with intensive perioperative cares and it would contribute more favorable prognosis.

Aged↗

PubMed1989

[Cervico-thoracic-abdominal lymph node dissection for carcinoma of the thoracic esophagus].

Over the period from 1982 to 1988, 127 cases with carcinoma in the thoracic esophagus underwent curative resection through a right thoracotomy. Cervicothoracic-abdominal lymph node dissection was performed in twenty-seven cases. No operative death occurred and only one hospital death (4%) was recorded. The only postoperative complication was recurrent laryngeal nerve palsy. Based on the adjusted survival-rate curves using Cox's method, there was significant difference in prognosis in favor of these 27 cases that received cervicothoracic-abdominal lymph node dissection over those that did not. The survival rate of all curatively operated cases was noticeably improved by using this procedure. Of those that underwent dissection only, or dissection with postoperative radiotherapy or chemotherapy, the best prognosis could be reached by a combination of the cervicothoracic-abdominal lymph node dissection and postoperative chemotherapy. From follow-up data regarding recurrence rates, a more extended dissection and complete removal of lymph nodes in the left upper mediastinum and retroperitoneum should further improve the long-term prognosis.

Abdomen↗

PubMed1989

Axillary dissection in breast cancer revisited.

The pathological status of the axillary nodes remains the single most determining factor for survival, local recurrence and disease-free interval in operable breast cancer. Radical axillary dissection results in better local control with or without systemic disease in all operable cases. In pathologically negative cases, radical axillary dissection decreases local recurrence rates and perhaps prolongs disease-free survival. In pathologically positive cases, radical axillary dissection improves local control only. Radical axillary dissection avoids axillary irradiation and so decreases the risk and the importance of lymphoedema. Perfect axillary dissection does not show a decisive advantage over less complete axillary dissection when the 'quality' of surgery is measured by lymphoscintigraphy, but it should be kept in mind that only total control of the local situation can ensure a patient free of distal spread at the time of first therapy.

Axilla↗

PubMed1989

Axillary dissection for breast carcinoma. The myth of skip metastasis.

The question of what constitutes an adequate axillary dissection for breast cancer remains open for debate. Central to this controversy is whether axillary nodal metastasis occurs in a stepwise fashion or spreads sporadically, creating skip metastases. The therapeutic aim of axillary dissection also must be considered. To resolve this controversy, a prospective study involving 129 patients who underwent complete axillary dissection for breast carcinoma was performed. The tissue from the axillary dissections was divided intraoperatively and sent to the pathologist as two specimens. The first specimen contained all nodes lateral to the pectoralis minor muscle (Level I), whereas the second contained all nodes beneath and medial to the pectoralis minor (Levels II and III). The tissue was analyzed to determine the frequency of skip metastasis. Only two patients, 1.6 per cent of the total group or 3.2 per cent of the positive node group, were found to have a positive node in Level II-III with no metastasis in Level I. A thorough dissection of Level I alone is sufficient to detect more than 98 per cent of all axillary lymph node metastases from breast cancer. Thus, proper staging of the disease can be obtained. When Level I contained positive nodes, the probability of metastatic disease to higher levels was significant (45%), indicating further treatment is necessary in incomplete axillary dissections.

Breast Neoplasms↗

PubMed1989

[Histopathological study on the safety of conservative breast surgery in terms of the degree of axillary dissection for breast cancer].

The subjects were 15 patients with primary mammary cancer who underwent radical mastectomy. Axillary dissection (level I, II and III) with an incision 7 cm below the axilla was performed. After radical mastectomy, the presence/absence of remaining lymph nodes and fatty tissue was determined. All operations were performed by the same surgeon. The number of lymph nodes dissected by means of subaxillary incision ranged from 10 to 32 (mean 20.4). The proportion of remaining lymph nodes found after radical mastectomy was 0/142 (0%) for level I, 0/113 (0%) for level II and 3/54 (5.6%) for level III. In the subclavian Halsted area, fatty tissue partially remained in 60.0% of the patients and more than half in 13.3%. It was shown that complete dissection of level III lymph nodes is difficult when this surgical technique is employed. Although fatty tissue did remain in some cases after level II dissecting, this technique presented hardly any problems in the case of level I and II dissection. Therefore, from the viewpoint of axillary dissection alone, the present technique can achieve results similar to those obtained by radical mastectomy, suggesting its applicability to mammary cancer at a relatively early stage.

Adipose Tissue↗

PubMed1983

[Esophageal varices and portal hypertension in children; experiences with Vossschulte's method of dissection ligature].

The optimal treatment of esophageal varices in childhood is an unresolved issue. Despite numerous studies concerning this topic, there seems to be no completely satisfying solution. An open and functioning portasystemic shunt provides a high degree of protection against esophageal variceal bleeding. However, technical obstacles imposed by the size of vessels available for shunting, reluctance to remove the spleen in a child and abnormalities of the portal vein often preclude successful portasystemic shunting in children. Therefore, a two-stage management has been proposed for the treatment of esophageal varices in childhood. In this approach Vossschulte's dissection-ligature has been utilized as a temporizing procedure. This operation has to bridge the time, until a decompressive shunt can be accomplished. Nine children with esophageal varices were treated by the dissection-ligature. There was no operative mortality. One patient succumbed during the follow-up period. One patient had a recurrent bleeding after 2 2/12 yrs, and underwent a shunting procedure at that time. Three patients had an esophageal stricture and swallowing difficulties. They were without complaints after a few dilatations. Data obtained from this study and from the literature indicate, that the dissection-ligature is safe and effective in controlling esophageal variceal bleeding. The dissection-ligature satisfies as temporary measure in the proposed two-stage management. Since many patients did not have any new bleeding-episodes and did not need any further surgery as well, it may be suggested that the dissection-ligature is not only suitable for temporary treatment, but also for permanent treatment. The dissection-ligature of Vossschulte should be kept in mind, if one is forced to consider a 'direct operation' of esophageal varices.

Child↗

PubMed1993

The case for wide local excision and regional node dissection for high-risk cutaneous melanoma.

For melanomas less than 1 mm thick, a 1-cm margin is considered adequate by most authors. For melanomas 1 to 4 mm thick, the results of the Intergroup Melanoma Trial in the United States suggest that a 2-cm margin is adequate. European studies indicate that a 1-cm margin may be satisfactory for all melanomas 2 mm thick or less. Elective node dissection is not indicated for melanomas less than 1 mm thick. Survival benefit has not been shown in two prospective studies, although retrospective studies suggest that elective node dissection improves the survival of patients with intermediate melanomas 1 to 4 mm thick. Elective dissection is more likely to benefit patients at high risk of harboring microscopic disease in the regional nodes, such as men with melanomas 1 to 4 mm thick or women with 2- to 4-mm lesions. For melanomas thicker than 4 mm, elective dissection is generally not indicated, except for staging purposes in the context of a protocol because the predominant mode of dissemination in this group is hematogenous. Therapeutic dissection is indicated in all patients with clinically suspicious regional nodes and no evidence of distant dissemination. In doubtful cases, a biopsy of the node may be done, to be followed, if the results are positive, with the definitive procedure. Although the majority of these patients relapse, the surgical treatment offers appreciable 5-year survival rates which cannot, at present, be attained by other modalities. Some evidence suggests that prompt detection of palpable regional nodes and thorough dissection improve the survival rates.

Biopsy↗

PubMed1995

Indications for seminal vesicle biopsy and laparoscopic pelvic lymph node dissection in men with localized carcinoma of the prostate.

PURPOSE: The ability of seminal vesicle biopsy and laparoscopic pelvic lymph node dissection to identify patients with stage T3 or N+ disease before undergoing treatment for localized carcinoma of the prostate was investigated. MATERIALS AND METHODS: A total of 157 patients with clinical stages T1a to T2c prostate cancer underwent ultrasound guided seminal vesicle biopsy (3 on each side) and 130 underwent subsequent laparoscopic pelvic lymph node dissection. RESULTS: Of 157 patients 23 (14.6%) had a positive seminal vesicle biopsy. Predictors of a positive seminal vesicle biopsy were stages T2b to T2c versus T1a to T2a disease (20% versus 4%, respectively, p = 0.005), Gleason score 7 or more versus less than 7 (34% versus 9%, respectively, p < 0.0001) and prostate specific antigen (PSA) 4 to 10 ng./ml., 10 to 20 ng./ml. or more than 20 ng./ml. (9%, 14% and 27%, respectively, p = 0.03). Of 130 patients 14 (10.7%) had a positive laparoscopic pelvic lymph node dissection. Predictors for a positive laparoscopic pelvic lymph node dissection were Gleason score 7 or more versus less than 7 (32% versus 2%, respectively, p < 0.0001), PSA more than 20 ng./ml. or less than 20 ng./ml. (24% versus 4.5%, respectively, p = 0.009) and stage T2b or T2c (15% and 24%, respectively, p = 0.056). Of the patients with a positive seminal vesicle biopsy 48% had a positive laparoscopic pelvic lymph node dissection (p < 0.0001). CONCLUSIONS: All patients with a Gleason score more than 4, PSA more than 10 ng./ml. or clinical stage T2b or more should undergo seminal vesicle biopsy, and those with a positive seminal vesicle biopsy or Gleason score 7 or greater should undergo laparoscopic pelvic lymph node dissection before initiating therapy for localized carcinoma of the prostate.

Aged↗

PubMed1995

[A clinicopathological study on extensive lymph node dissection for thoracic esophageal cancer].

In order to evaluate clinical effect of the extensive lymph node dissection for thoracic esophageal cancer, 78 cases with esophagectomy and extensive lymph node dissection were reviewed. Pathological depth of invasion was the submucosa (sm: 25 cases), the proper muscle (pm: 7 cases), al (8 cases) and a2 (38 cases). Incidence of operative death rate in 30 days was 2.8% of all cases and hospital death rate 5.1%. Lymph node metastasis was identified in 65% of all cases (cervical metastasis occupied 19.2% of all cases with metastasis, mediastinal metastasis 48.7% and abdominal metastasis 34.6%). Over all cumulative three year survival rate was 55.3% (sm 88.9%, pm & al 55.6% and a2 40%). Postoperative recurrence was analyzed on thirty eight cases with more than three years passed after esophagectomy with extensive lymph node dissection. Postoperative recurrence was detected in 50% of all cases (local recurrence occupied 16% of all cases with recurrence, distant organ metastasis 58%, lymph node metastasis 21% and dissemination 5%). Extensive lymph node dissection significantly elongated disease free interval and survival time of cases with recurrence and lymph node metastasis, but there was no significant improvement in cases with other mode of recurrence. Dissecting field was classified into four regions (cervical, paratracheal, periesophageal and abdominal regions). Number of lymph nodes with metastasis and number of regions with lymph node metastasis showed close relationship with incidence of post operative recurrence. In cases with number of lymph node metastasis more than six and in more than two regions, all cases resulted in recurrence. Extensive lymph node dissection have an effect improving survival rate on cases with number of lymph node metastasis less than five and in less than two regions.

Aged↗

PubMed1994

Role of lymph node dissection and splenectomy in node-positive gastric carcinoma.

BACKGROUND: In gastric carcinoma the relationship between survival of patients and degree of lymph node dissection is still controversial and there is no agreement about the efficacy of extended lymph node dissection and splenectomy. METHODS: Long-term results after surgery were statistically analyzed in 240 patients who underwent curative gastrectomy with lymph node dissection for node-positive gastric carcinoma from 1975 to 1990. RESULTS: The survival of patients was not significantly different among R1, R2, and R3 dissections, with the 10-year survival rate being 57%, 50%, and 44%, respectively. The survival rate was also not different between R2 and R3, even when the cases were stratified by the level of lymph node metastasis (N1, 66% vs 58%; N2, 28% vs 31%). The survival of patients was not significantly different between cases treated without splenectomy and those treated with splenectomy, with 10-year survival rates being 47% and 26%, respectively. The survival rate was also not different between non-splenectomy- and splenectomy-treated cases, even when the patients were compared in the same level of lymph node metastasis (N1, 60% vs 45%; N2, 23% vs 11%). CONCLUSIONS: In cases of curative gastrectomy the survival time of patients was not influenced by the level of lymph node dissection and splenectomy. For the treatment of node-positive gastric carcinoma (N1, N2) the long-term efficacy of R3 dissection and splenectomy seems limited.

Female↗

PubMed1994

Preoperative mediastinoscopic assessment of N factors and the need for mediastinal lymph node dissection in T1 lung cancer.

The significance of preoperative N factor assessment in T1 lung cancer and the need for mediastinal node dissection in T1 N0 M0 cases were investigated. The results of mediastinoscopy were evaluated in patients with T1 adenocarcinoma or squamous cell carcinoma who underwent preoperative mediastinoscopy and thoracotomy from 1971 to 1991 (n = 164). Mediastinoscopy gave true negative results in 90% of patients, false negative in 1%, and true positive in 9%. The 5-year survival was 90% for patients with T1 N0 M0 disease who underwent nonradical dissection (n = 64) and 70% for those who underwent radical dissection (n = 61), indicating that the prognosis was significantly better (p < 0.05) with nonradical dissection. Distant metastasis was a common cause of death, and no death was related to local recurrence, whether nonradical or radical dissection had been performed. The results strongly suggest that preoperative mediastinoscopy and intraoperative node sampling are sufficient for assessment of N factors in T1 lung cancer. The possible relation between immunologic functional changes associated with mediastinal lymph node dissection and the prognosis in patients without evidence of positive lymph nodes should be clarified by a prospective randomized study.

Adenocarcinoma↗