OBJECTIVETo consider the relationship to survival rate and quality of life with pararectal lymphadenectomy for lower carcinoma of rectum.

METHODSThe radical operation was performed on 780 cases of progressive cancer located at peritoneal reflection or below it, Among them, 352 cases only cleared in abdominal cavity, 428 cases coupled with extra-peritoneal histopathological type.

RESULTSUrinary function injured, the group cleared in abdominal cavity was 12 cases, accounted for 3.6%; the group coupled with extra-peritoneal clearance was 225 cases, for 52.5% (P < 0.01). Sexual function damaged (only for male), the abdominal cavity group was 23 cases, for 12.6% (23/185); the coupled group was 127 cases, for 53.4% (127/238), (P < 0.01). Local relapse rate, the abdominal cavity group was 15.8% (56/352); the coupled group was 8.6% (41/428), (P < 0.05). 5-year survival rate, the abdominal cavity group was 52.2%; the coupled group was 58.5% (P < 0.05).

CONCLUSIONBy contrast, although abdominal cavity coupled with extraperitoneal lymphadenectomy acted to cut down local relapse and to elevate 5-year survival rate, the postoperative quality of life appeared to be seriously affected.

Female ; Humans ; Lymph Node Excision ; methods ; Male ; Proctocolectomy, Restorative ; Quality of Life ; Rectal Neoplasms ; mortality ; pathology ; surgery ; Retrospective Studies ; Survival Rate

OBJECTIVETo investigate the disciplinarian of lymph node metastasis and evaluate the effect of paraaortic lymph nodes dissection on the clinical outcomes in advanced gastric carcinoma.

METHODSOne hundred and twenty-six patients who underwent D(3) (including D(3)(+)) radical resection (group D(3)) and 146 patients who underwent D(2) radical resection by the same surgical team (group D(2)) for advanced gastric cancer were enrolled in the present study. The dissected lymph nodes were grouped according to the definition of Japanese Research Society for the Study of Gastric Cancer (JRSGC) (Edition 13th). The lymph node metastasis was analyzed in group D(3). The clinicopathological characteristics and clinical outcomes were compared between the two groups.

RESULTSThere were no differences in age, sex, tumor location, Borrman type, histological type and TNM stage between group D(2) and group D(3) (P > 0.05). The No16 lymph node metastatic rate was 3.8%, 22.3%, 46.8% and 32.1% in T(1), T(2), T(3), T(4) stage tumors respectively, 16.3% and 69.5% in the patients with negative and positive serosal invasion respectively; there were no differences in operative mortality (2/126 vs 2/146) and surgical complications (4/126 vs 6/146) between group D(2) and group D(3) (P > 0.05). The 5-year survival rate was 66.5% in group D(3) and 40.2% in group D(2) (P< 0.01). The 5-year survival rates of the patients with I, II, IIIa, IIIb and IV stage tumors who were No16 lymph nodes negative were 94.8%, 95.6%, 72.1%, 58.6%, 59% respectively in group D(3), and 42%, 36%, 27%, 35.6%, 16.3% respectively in group D(2). The 5-year survival rate of the patients with No16 (+) lymph nodes less than 3 was higher than that of the patients with No16(+) lymph nodes more than 3.

CONCLUSIONSNo16a2 and No16b1 are the common locations of lymph node metastasis in advanced gastric cancer. The paraaortic lymph node metastasis closely is related with the depth of tumor invasion and serosal invasion. Paraaortic lymph nodes dissection (D(3) or D(3)(+) radical resection) improves the 5-year survival rate of the patients with No16 (-) and No16 (+) lymph nodes less than 3.

Female ; Humans ; Lymph Node Excision ; methods ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; pathology ; Male ; Neoplasm Staging ; Prognosis ; Stomach Neoplasms ; mortality ; pathology ; surgery ; Survival Rate ; Treatment Outcome

OBJECTIVETo review the experience of the diagnosis, surgical treatment and prognosis of metachronous second primary lung cancers.

METHODSBetween January 1983 and April 2004, 32 patients with metachronous second primary lung cancers were operated in our department. Clinical data of all these patients were reviewed retrospectively.

RESULTSThe initial procedures for their first primary lung cancers were lobectomy or pneumonectomy. Lobectomy or completion pneumonectomy for the second primary lung cancers were performed in 17 cases, limited pulmonary resection was done in 14 cases and exploration was in 1 case. The postoperative morbidity and mortality were 12% (4/32) and 3% (1/32), respectively. The 1-, 3-, and 5-year survival rate after second operation were 66% (19/29), 32% (9/28) and 19% (4/21), respectively.

CONCLUSIONSThe incidence of metachronous second primary lung cancers has been increasing gradually during recent years. The closely follow-up for patients undergoing resection for their first primary lung cancers is most important factor for improvement of the diagnosis of metachronous second primary lung cancers. Limited resection and incomplete lymph node dissection might be the factors contributing to the poor prognosis.

Adult ; Aged ; Female ; Humans ; Lung Neoplasms ; diagnosis ; mortality ; pathology ; surgery ; Lymph Node Excision ; Male ; Middle Aged ; Neoplasms, Second Primary ; diagnosis ; mortality ; pathology ; surgery ; Pneumonectomy ; methods ; Prognosis ; Retrospective Studies

OBJECTIVETo evaluate prognostic factors which have an influence on overall survival and to assess the rational application of retroperitoneal lymphadenectomy in patients with epithelial ovarian cancer.

METHODSThe data of 131 patients treated between January 1990 and December 1998 in Union Hospital and Tongji Hospital were analyzed retrospectively. Survival was calculated using the Kaplan-Meier method and comparisons were performed using Log-rank test. Independent prognostic factors were identified by the Cox proportional hazards regression model.

RESULTSUnivariate analysis showed that age, general conditions, menopausal status, stage, pathological types, location of the tumor, residual tumor and retroperitoneal lymphadenectomy were prognostic factors. Multivariate analysis showed that age, stage, residual tumor, retroperitoneal lymphadenectomy and the number of courses of chemotherapy were the most important prognostic factors. The survival rate could not be improved through retroperitoneal lymphadenectomy in the patients in early stage, advanced stage with residual tumor > 2 cm or those with mucinous adenocarcinoma (P > 0.05). Among patients in advanced stage cancer with a residual tumor

CONCLUSIONSThe prognosis of the patients with epithelial ovarian cancer may be influenced by age, stage, residual tumor, retroperitoneal lymphadenectomy and the number of courses of chemotherapy. Although retroperitoneal lymphadenectomy could improve the survival rate, it should be carried out selectively.

Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Lymph Node Excision ; methods ; Middle Aged ; Neoplasms, Glandular and Epithelial ; mortality ; surgery ; Ovarian Neoplasms ; mortality ; surgery ; Prognosis ; Retroperitoneal Space ; Survival Rate

OBJECTIVETo investigate the complications and oncologic outcomes of 210 cases of bladder urothelial carcinoma (BUC) treated with laparoscopic radical cystectomy (LRC) with extended pelvic lymph node dissection (EPLND) and assess the feasibility and safety of this surgical technique.

METHODSFrom January, 2003 to March 2010, 210 patients with BUC underwent LRC with EPLND. The cases with positive lymph nodes or T3a disease received adjuvant chemotherapy after the operation. The complications and oncologic results were recorded and analyzed.

RESULTSThe mean operative time was 105 min in these cases with a mean blood loss of 220 ml and a rate of perioperative blood transfusion of 20.5%. The mean number of harvested lymph nodes was 17.6, and 42 (20%) cases were found to have positive lymph nodes. Minor and major perioperative complications occurred in 19% and 5.3% of the cases, respectively. The 5-year estimated overall survival, cancer-specific survival, recurrence-free survival and metastasis-free survival rates were 73.8%, 83.3%, 81.8% and 90.5%, respectively.

CONCLUSIONSLRC with EPLND is a safe and feasible technique for management of BUC and can produce satisfactory oncologic results.

Cystectomy ; adverse effects ; methods ; Female ; Humans ; Laparoscopy ; Lymph Node Excision ; adverse effects ; methods ; Male ; Middle Aged ; Postoperative Complications ; Survival Rate ; Treatment Outcome ; Urinary Bladder Neoplasms ; mortality ; surgery

OBJECTIVE: To investigate the clinical significance of systematic retroperitoneal lymphadenectomy during interval debulking surgery (IDS) in advanced epithelial ovarian cancer (EOC) patients. METHODS: We retrospectively reviewed the medical records of 124 advanced EOC patients and analyzed the details of neoadjuvant chemotherapy (NACT), IDS, postoperative treatment, and prognoses. RESULTS: Following IDS, 98 patients had no gross residual disease (NGRD), 15 had residual disease sized <1 cm (optimal), and 11 had residual disease sized > or =1 cm (suboptimal). Two-year overall survival (OS) and progression-free survival (PFS) rates were 88.8% and 39.8% in the NGRD group, 40.0% and 13.3% in the optimal group (p<0.001 vs. NGRD for both), and 36.3% and 0% in the suboptimal group, respectively. Five-year OS and 2-year PFS rates were 62% and 56.1% in the lymph node-negative (LN-) group and 26.2% and 24.5% in the lymph node-positive (LN+) group (p=0.0033 and p=0.0024 vs. LN-, respectively). Furthermore, survival in the LN+ group, despite surgical removal of positive nodes, was the same as that in the unknown LN status group, in which lymphadenectomy was not performed (p=0.616 and p=0.895, respectively). Multivariate analysis identified gross residual tumor during IDS (hazard ratio, 3.68; 95% confidence interval, 1.31 to 10.33 vs. NGRD) as the only independent predictor of poor OS. CONCLUSION: NGRD after IDS improved prognosis in advanced EOC patients treated with NACT-IDS. However, while systematic retroperitoneal lymphadenectomy during IDS may predict outcome, it does not confer therapeutic benefits.
Adult ; Aged ; Aged, 80 and over ; Cytoreduction Surgical Procedures/*methods/mortality ; Disease-Free Survival ; Female ; Humans ; Lymph Node Excision/*methods/mortality ; Lymphatic Metastasis ; Middle Aged ; Neoplasms, Glandular and Epithelial/mortality/*surgery ; Ovarian Neoplasms/mortality/*surgery ; Retroperitoneal Space ; Retrospective Studies ; Treatment Outcome

BACKGROUNDRecent studies have revealed that the reason for the low surgical resection rate of pancreatic carcinoma partly lies in its biological behavior, which is characterized by neural infiltration. This study aimed to investigate the clinical significance of radical pancreatoduodenectomy combined with retroperitoneal nerve, lymph, and soft-tissue dissection for carcinoma of the pancreatic head.

METHODSForty-six patients with pancreatic head cancer were treated in our hospital from 1995 to 2005. The patients were divided into two groups: radical pancreatoduodenectomy combined with retroperitoneal nerve, lymph and soft-tissue dissection (group A, n = 25) and routine Whipple's operation (group B, n = 21). There were no significant differences between the two groups in relation to age, gender and preoperative risk factors, and perioperative conditions, pathological data and survival rates were studied.

RESULTSThere were no significant differences in tumor size, surgical procedure time, postoperative complications, and time of hospitalization. However, the number and positive rate of resected lymph nodes in group A were significantly higher than those in group B (P < 0.05). The 1- and 3-year survival rate in group A were 80% and 53%, respectively, which was higher than those in group B (P < 0.05). There were significant differences in the survival rates between patients with and without nerve infiltration in group A (P < 0.05).

CONCLUSIONSRadical pancreatoduodenectomy combined with retroperitoneal nerve, lymph and soft-tissue dissection, can effectively remove the lymph and nerve tissues that were infiltrated by tumor. Meanwhile, this method can reduce the local recurrence rate so as to improve the long-term survival of patients.

Cause of Death ; Humans ; Lymph Node Excision ; Pancreatic Neoplasms ; pathology ; surgery ; Pancreaticoduodenectomy ; adverse effects ; methods ; mortality ; Retroperitoneal Space ; innervation ; pathology ; surgery ; Survival Rate

Primary adenocarcinoma of duodenum is an uncommon neoplasm. Besides its rarity, vague symptoms and signs with the lack of physical findings can delay diagnosis and result in poor treatment outcome. Aggressive surgical managements including pancreaticoduodenectomy was generally recommended for localized cancers despite high operational mortality. However, if early stage cancer is detected, wedge resection can be a therapeutic option. The authors encountered a 2.5x1.5 cm sized subepithelial tumor like mass with spontaneous bleeding and central dimpling located in the third portion of duodenum on esophagogastroduodenoscopy. After repeated deep biopsy, the patient underwent wedge resection and regional lymph node dissection of the duodenum. Finally, the mass was proven as adenocarcinoma and the patient remains in good condition without recurrence for over 2 years. Due to it's low incidence and high mortality, meticulous endoscopic examination of duodenum is essential for early diagnosis and limited operational methods may improve survival and quality of life of patients.
Adenocarcinoma* ; Biopsy ; Diagnosis ; Duodenal Neoplasms ; Duodenum* ; Early Diagnosis ; Endoscopy, Digestive System ; Hemorrhage ; Humans ; Incidence ; Lymph Node Excision ; Methods ; Mortality ; Pancreaticoduodenectomy ; Quality of Life ; Recurrence ; Treatment Outcome

Primary adenocarcinoma of duodenum is an uncommon neoplasm. Besides its rarity, vague symptoms and signs with the lack of physical findings can delay diagnosis and result in poor treatment outcome. Aggressive surgical managements including pancreaticoduodenectomy was generally recommended for localized cancers despite high operational mortality. However, if early stage cancer is detected, wedge resection can be a therapeutic option. The authors encountered a 2.5x1.5 cm sized subepithelial tumor like mass with spontaneous bleeding and central dimpling located in the third portion of duodenum on esophagogastroduodenoscopy. After repeated deep biopsy, the patient underwent wedge resection and regional lymph node dissection of the duodenum. Finally, the mass was proven as adenocarcinoma and the patient remains in good condition without recurrence for over 2 years. Due to it's low incidence and high mortality, meticulous endoscopic examination of duodenum is essential for early diagnosis and limited operational methods may improve survival and quality of life of patients.
Adenocarcinoma* ; Biopsy ; Diagnosis ; Duodenal Neoplasms ; Duodenum* ; Early Diagnosis ; Endoscopy, Digestive System ; Hemorrhage ; Humans ; Incidence ; Lymph Node Excision ; Methods ; Mortality ; Pancreaticoduodenectomy ; Quality of Life ; Recurrence ; Treatment Outcome

OBJECTIVETo investigate the essentials of operation and the postoperative effect of right hemicolonic carcinoma with anterograde clearance of lymph nodes.

METHODSOne hundred and thirty-five patients with right hemicolonic infiltrated carcinoma, who were eligible for radical excision (D(3)), were divided into 2 groups. Among them, the anterograde clearance of lymph nodes was performed on 56 cases; the retrograde clearance was performed on 79 cases. Both groups showed no significant difference in age, sex, Dukes' staging and pathological type.

RESULTSThe average time of operation: the anterograde group was (180 +/- 40) min; the retrograde group was (180 +/- 20) min. The average amount of bleeding: the anterograde group was (200 +/- 80) ml; the retrograde group was (200 +/- 30) ml. The cleared number of lymph nodes: the anterograde group were 6.3 +/- 4.2, 2.6 +/- 3.1, 1.5 +/- 2.3 in paracolon, middle and radicel of vasorum respectively, the total number was 11.4 +/- 8.6; the retrograde group were 6.4 +/- 2.2, 2.8 +/- 2.1, 1.1 +/- 1.1 respectively, the total number was 10.8 +/- 5.6 (P > 0.05). The postoperative metastasis to liver: the anterograde group was 8 cases (13.9%); the retrograde group was 21 cases (26.6%, P < 0.05). The 5-year survival rate: the anterograde group was 72.8% (41/56); the retrograde group was 65.5% (52/79) (P < 0.05).

CONCLUSIONSThe operative technique of the excision was little difficulty and complexity, and it could fit well with the requirement of non touch isolation, and act to cut down the postoperative metastasis to liver and to elevate 5-year survival rate.

Adult ; Colonic Neoplasms ; mortality ; surgery ; Female ; Follow-Up Studies ; Humans ; Lymph Node Excision ; methods ; Male ; Middle Aged ; Retrospective Studies ; Survival Rate ; Treatment Outcome