Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Humans ; Lymph Node Excision

Surgery is the mainstay treatment of the multidisciplinary therapy for gastric cancer. The majority of gastric cancer patients in China are diagnosed at the advanced stage. D2 lymphadenectomy is of clinical significance in China. The technical aspects of performing a D2 lymphadenectomy require a significant degree of training and expertise. In this article, the focus is on the dissection of lymph nodes including No.4Sb, No.5-6, No.8a, No.9-11, No.12a, and No.14-15.
Humans ; Lymph Node Excision ; methods ; Stomach Neoplasms ; surgery

Laparoscopy-assisted D2 radical distal gastrectomy has been acknowledged as standard procedure for local advanced gastric cancer. But due to the abundant blood vessels and complicated anatomy of the stomach, lymphadenectomy has been considered as one of the difficulties of the operation, especially in the supra-pancreatic area. This article is to share the experiences of this topic from Department of Gastrointestinal Oncology Surgery, The First Affiliated Hospital of Xiamen University with the following five aspects. (1) How to dissect No.11p lymph nodes thoroughly and whether the exposure of splenic vein is needed? (2) Is it necessary to reveal portal vein during the lymphadenectomy of supra-pylorus and supra-pancreatic areas?(3) During laparoscopic operation, where is the posterior boundary of No.9 lymph nodes at the right side of celiac artery?(4) How to make it easier, safer, and more complete for supra-pancreatic lymphadenectomy? (5) How to deal with the tandem enlarged lymph nodes at the right side of celiac artery? According to the authors' experiences of laparoscopic radical gastrectomy, the following points may be helpful to make the supra-pancreatic lymphadenectomy safe, complete, and standard: (1) Transection of vessels of duodenum, right stomach and left stomach in advance will make the lymphadenectomy at the right side of the celiac artery easier. (2) The exposure of splenic vein as far as possible is necessary during the dissection of No.11p lymph nodes, and it is necessary to dissect the lymph-adipose tissue at the posterior-superior border of splenic artery and pancreas in front of Gerota fascia. (3) The left side of portal vein must be revealed initiatively for dissection of No.12a lymph nodes. (4) The lymph-adipose tissue must be dissected at the included angle of common hepatic artery and celiac artery and the right wall of the celiac artery should be revealed during the dissection of No.8a and the right side of No.9 lymph nodes. (5) The exposure of portal vein and the transection of left gastric vein at the root will make the dissection of this area safer and complete. (6) En bloc D2 plus operation will be a better option, when comfronted with tandem enlarged lymph nodes at the right side of celiac artery.
Gastrectomy ; methods ; Humans ; Laparoscopy ; Lymph Node Excision ; Stomach Neoplasms ; surgery

No abstract available.
Endometrial Neoplasms/*pathology ; Female ; Humans ; Lymph Node Excision/*methods ; *Sentinel Lymph Node Biopsy

No abstract available.
Endometrial Neoplasms/*pathology ; Female ; Humans ; Lymph Node Excision/*methods ; *Sentinel Lymph Node Biopsy

In the standardized diagnosis and treatment process of advanced gastric cancer, there is a unappreciated key link between standard radical surgery and accurate pathological reports. That is, the process of dissection, fixation, sampling and recording of the specimen by the surgeons, starting from specimen isolation to the management of the pathologist. Standardizing this process can not only accurately reflect the detailed distribution and exact number of lymph nodes, but also clarify the pathological stage of gastric cancer, so as to make adjuvant treatment plans. Moreover, it can also reflect the scope of intraoperative lymph node dissection to ensure the standardized implementation of surgery, including the overall dissection principle (en bloc resection), and therefore can provide a solid foundation for later related researches. So far, there is still a lack of complete and unified standard for the surgical management of specimens after radical gastrectomy in China. On the basis of the relevant researches and clinical practice about specimen management at home and abroad, the Chinese Journal of Gastrointestinal Surgery, in the name of the Gastric Cancer Professional Committee, Chinese Anticancer Association, as well as the Oncogastroenterology Professional Committee, Chinese Anticancer Association, organized dozens of experts to formulate a consensus on the standardized surgical management of specimens after repeated discussions and revisions for two years. This consensus is aimed to standardize the preparations, basic requirements and sample processing procedures before the surgical treatment of postoperative specimens after a radical surgery for gastric cancer patients, including the processing time of specimens, the processing and data archiving of gastric specimens, and lymph node grouping, sorting and fine sorting records, etc and with the purpose of standardizing the surgical treatment of postoperative specimens on the basis of standardized diagnosis and treatment of gastric cancer, in order to further promote the high-quality development of gastric cancer surgery in China.
Consensus ; Gastrectomy/methods* ; Humans ; Lymph Node Excision/methods* ; Lymph Nodes/pathology* ; Stomach Neoplasms/surgery*

Due to the anatomical specificity of esophagus, esophagectomy can be carried out using different approaches, such as left transthoracic, right transthoracic and transhiatal approaches. Each surgical approach is associated with a different prognosis due to the complex anatomy. The left transthoracic approach is no longer the primary choice due to its limitations in providing adequate exposure, lymph node dissection, and resection. The right transthoracic approach is capable of achieving a larger number of dissected lymph nodes and is currently considered the preferred procedure for radical resection. Although the transhiatal approach is less invasive, it could be challenging to perform in a limited operating space and has not been widely adopted in clinical practice. Minimally invasive esophagectomy offers a wider range of surgical options for treating esophageal cancer. This paper reviews different approaches to esophagectomy.
Humans ; Prognosis ; Lymph Node Excision/methods* ; Lymph Nodes/pathology* ; Esophageal Neoplasms/pathology* ; Esophagectomy/methods*

Laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPL) is a operation conducted experimentally in the current. Current reports showed that it can be safely completed through different approach, such as the right, left, medial and retropancreatic approach. This paper summarized the steps and characteristics of different approaches LSPL and compared the differences between each other. The application status of LSPL in laparoscopy-assisted radical gastrectomy were reviewed. The security, feasibility and the problem to be solved of LSPL, improvement measure also be explored in this paper.
Gastrectomy ; methods ; Humans ; Laparoscopy ; Lymph Node Excision ; methods ; Lymph Nodes ; Spleen ; Stomach Neoplasms ; surgery

Surgical resection remains the cornerstone of the multidisciplinary treatment for patient with localized esophageal cancer. Lymphadenectomy is a pivotal step of radical esophagectomy, which is advanced technique required. Although the consensus on mediastinal lymph node dissection in the radical esophagectomy had been published in China, no agreement or consensus are available on the abdominal lymph node dissection. Based on the latest guidelines or consensuses, available clinical evidence, and agreements from Chinese expert panel of abdominal lymph node dissection in the radical esophagectomy, Chinese Society of Esophageal Cancer, China Anti-cancer Association organized experts to discuss and write this consensus. The expert consensus focuses on the key points of and makes recommendations for surgical approach, extent of lymphadenectomy, quality control and complication management for abdominal lymph node dissection in the radical esophagectomy in China. Applying a standard and efficient abdominal lymph node dissection in the radical surgical resection for patient with esophageal cancer is important and indispensable.
Humans ; Esophagectomy/methods* ; Consensus ; Lymph Node Excision/methods* ; Esophageal Neoplasms/pathology* ; China ; Lymph Nodes/pathology*

Radical resection of gastrointestinal tumors based on the membrane anatomy theory has significantly reduced the postoperative recurrence rate and improved the surgical efficacy. However, the theory of membrane anatomy has not been widely adopted in radical surgery for esophageal cancer. Our study found that the esophagus also has a membranous anatomical structure. As a foregut organ, the esophagus also has a mesenteric structure, and there is also a fifth metastasis pathway within the esophageal mesentery for esophageal cancers. The leak and metastasis of cancer caused by destruction of the mesenteric integrity may be the fundamental reason for the high postoperative recurrence rate. Using the nano carbon and indocyanine green fluorescence tracing technique, we demonstrated the lymphatic drainage of the upper esophageal segment to the left gastric artery mesenteric lymph nodes. Therefore, in the radical resection of esophageal cancer, we used the membrane anatomy theory for guidance to completely remove the esophageal cancer, esophageal mesentery, left gastric artery and its mesentery, as well as all structures within the mesentery, preventing the spread of cancer cells through the blood vessels, lymphatic system, and mesentery, and improving the efficacy and prognosis. This article elaborates on the theoretical basis of the anatomical structure of the esophageal membrane, embryonic development, imaging, autopsy, and endoscopic observation of the structure, as well as the application effect of the esophageal membrane anatomical theory in esophageal cancer radical surgery. It elucidates the anatomical structure of the esophageal membrane and the lymphatic drainage characteristics of esophageal cancer, reveals the law of lymphatic metastasis in esophageal cancer, optimizes lymphatic dissection strategies, and improves the efficacy of esophageal cancer radical surgery.
Humans ; Lymph Node Excision/methods* ; Esophageal Neoplasms/surgery* ; Lymph Nodes ; Endoscopy ; Dissection