OBJECTIVE: The aim of this paper was to demonstrate the techiniqes of single-port laparoscopic transperitoneal infrarenal paraaortic lymphadenectomy as part of surgical staging procedure in case of early ovarian cancer and high grade endometrial cancer. METHODS: After left upper traction of rectosigmoid, a peritoneal incision was made caudad to inferior mesenteric artery. Rectosigmoid was mobilized, and then the avascular space of the lateral rectal portion was found by using upward traction of rectosigmoid mesentery. Inframesenteric nodes were removed without injury to the ureter and the left common iliac nodes were easily removed due to the upward traction of the rectosigmoid. The superior hypogastric plexus was found overlying the aorta and sacral promontory, and presacral nodes were removed at subaortic area. Peritoneal traction suture to right abdomen was needed for right para-aortic lymphadenectomy. After right lower para-aortic node dissection, operator was situated between the patient's legs. After upper traction of the small bowel, left upper para-aortic nodes were removed. To prevent chylous ascites, we used hemolock or Ligasure application (ValleyLab Inc.) to upper part of infrarenal and aortocaval nodes. RESULTS: Single-port laparoscopic transperitoneal infrarenal para-aortic lymphadenectomy was performed without serious perioperative complications. CONCLUSION: Even though the technique of single-port surgery is still a difficult operation, the quality of single-port laparoscopic transperitoneal infrarenal para-aortic node dissection is excellent, especially mean number of para-aortic nodes. In cases of staging procedures for ovary and endometrial cancer, single-port transperitoneal para-aortic lymphadenectomy is acceptable as an oncologic procedure.
Endometrial Neoplasms/diagnosis/*pathology ; Female ; Humans ; Laparoscopy/adverse effects/methods ; Lymph Node Excision/adverse effects/*methods ; Neoplasm Staging/adverse effects/methods ; Ovarian Neoplasms/diagnosis/*pathology

No abstract available.
Female ; Humans ; Laparoscopy/adverse effects/*methods ; Neoplasm Staging ; Ovarian Neoplasms/pathology/*surgery

With the apparently increasing incidence of endometrial carcinoma, much importance has been attached to the early and exact diagnosis of endometrial carcinoma. This article mainly focuses on diagnostic techniques of endometrial carcinoma, especially diagnostic hysteroscopy and its assessment of myometrial invasion as well as stage of endometrial carcinoma. Whether hysteroscopy increases the risk of microscopic extrauterine spread is also discussed in this article.
Endometrial Neoplasms ; diagnosis ; pathology ; therapy ; Female ; Humans ; Hysteroscopy ; adverse effects ; methods ; Neoplasm Staging

Adult ; Aged ; Biopsy, Fine-Needle ; adverse effects ; methods ; Bronchi ; diagnostic imaging ; pathology ; Endosonography ; adverse effects ; methods ; Female ; Humans ; Lung Neoplasms ; diagnosis ; pathology ; Male ; Middle Aged ; Neoplasm Staging

Biopsy, Fine-Needle ; adverse effects ; methods ; Bronchi ; diagnostic imaging ; pathology ; Endosonography ; adverse effects ; methods ; Humans ; Lung Neoplasms ; diagnosis ; pathology ; Neoplasm Staging

BACKGROUND: Segmentectomy can retains more healthy lung tissue than lobectomy, but it remains controversial in oncology for early stage lung cancer. The aim of this study is to discuss the problems of video-assisted thoracic surgery (VATS) segmentectomy in early stage lung cancer, by analyzing the clinical and pathological data of 35 cases and reviewing the literature. METHODS: There were 35 patients who received segmentectomy by complete video-assisted thoracic surgery, from May 2013 to July 2017, in single operation group in the Third Hospital of Peking University. We analyzed the patient's clinical and pathological data, intraoperative and postoperative complications, lymph node number and metastasis its situation, and compared postoperative pathology and preoperative computed tomography (CT) imaging type. In 35 cases of segmentectomy, there were 11 males and 24 females, with an average age of 57.7 years old. The lesions located in the right upper lobe were 8 cases, in the right lower lobe were 8 cases, in the left upper lobe were 13 cases, in the left lower lobe were 6 cases. The mean maximum diameter of CT imaging was 12.7 mm, and the largest diameter of hilar and mediastinal lymph nodes was less than 10 mm. 23 of them were ground glass predominating and 12 were solid components predominating. RESULTS: All 35 cases were successfully completed VATS anatomical segmentectomy. The average operation time was 153 minutes, the amount of bleeding was 51 mL. There were 10 cases of air leakage after operation, all of which were not more than 3 days. There was contralateral atelectasis in 1 case, chylothorax in 1 case. The average length of hospitalization was 6.1 days. There was no other complications outpatient related to surgery, in 30 days after discharge. The pathological changes were as follow, 2 cases of metastatic tumor, 8 cases of benign lung disease and 25 cases of primary lung cancer. In the 25 cases of primary lung cancer, there were 14 cases of invasive lung adenocarcinoma (7 cases were groundglassopacity (GGO) predominating in CT imaging), 4 cases of micro-invasive adenocarcinoma (3 cases were GGO predominating in CT imaging), 6 cases of adenocarcinoma in situ (all were pure GGO in CT imaging), 1 case of lung squamous cell carcinoma (mainly composed of solid in CT imaging). An average of 7.2 lymph nodes were removed in 25 cases of lung cancer, and all lymph nodes had no metastasis. CONCLUSIONS VATS anatomical segmentectomy is technically safe and reliable, and the indications for lung cancer need to be strictly controlled. Its advantages still need to be confirmed by prospective randomized controlled trials.
Female ; Humans ; Lung Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Neoplasm Staging ; Retrospective Studies ; Thoracic Surgery, Video-Assisted ; adverse effects ; methods

BACKGROUND/AIMS: We made a systematic review and evaluation of endoscopic cryotherapy of endobronchial tumors, investigating safety and efficacy. METHODS: Qualified studies regarding endoscopic cryotherapy of lung tumors were systemically evaluated using available databases according to predefined criteria. RESULTS: In total, 16 publications were included in the final assessment. A narrative synthesis was performed because a formal meta-analysis was not viable due to the lack of controlled studies and study heterogeneity. Overall success rates for significant recanalization of the obstruction were approximately 80%, although they varied, depending on disease status in the patient population. Complications from the procedure developed in 0-11.1% of cases, most of which were minor and controlled by conservative management. Although limited data were available on comprehensive functional assessment, some studies showed that respiratory symptoms, pulmonary function tests, and performance status were significantly improved. CONCLUSIONS: Endoscopic cryotherapy was found to be a safe and useful procedure in the management of endobronchial tumors although its efficacy and appropriate indications have yet to be determined in well-designed controlled studies.
Bronchial Neoplasms/mortality/pathology/*surgery ; *Bronchoscopy/adverse effects ; Cryosurgery/adverse effects/*methods/mortality ; Humans ; Lung Neoplasms/mortality/pathology/*surgery ; Neoplasm Staging ; Risk Assessment ; Treatment Outcome

OBJECTIVETo investigate the intramural lateral spread distance in low rectal cancer in order to provide basis for safety lateral resection margin of pull-through conformal resection (PTCR).

METHODSThe patients with low rectal cancer who received low anterior resection or abdominal-perineal resection in Changhai Hospital from December 2015 to March 2016 were enrolled and Surgical specimens were collected. After the specimens were fixed in 10% formaldehyde for 24 hours, a piece of tissue that was 1.5 cm in length and 0.5 cm in width from the edge of tumor was cut. The tissue was obtained in the direction of 3, 5, 7 and 9 o'clock clockwise. The distance of intramural lateral spread was measured in the specimens and the risk factors were analyzed.

RESULTSA total of 83 specimens were collected and the overall proportion of intramural lateral spread was 71.1%(59/83). The rate of lateral spread from 3 to 9 o'clock was 34.9%(29/83), 26.5%(22/83), 32.5%(27/83) and 37.3%(31/83) respectively, and the difference was not statistically significant(χ=2.444 9, P=0.485 3). The median distance of lateral spread in each direction was all 0 mm and the quartile range was 1 mm, 0.5 mm, 0.55 mm and 1 mm respectively. The 5th percentile (P5) of each direction was all 0 mm and the 95th percentile(P95) of each direction was 2.5 mm, 1.6 mm, 2.6 mm, 2.5 mm, respectively and the difference was not statistically significant either(χ=5.331 0, P=0.148 9). The rate of lateral spread of T1, T2, T3 and T4 was 0/4, 58.3%(14/24), 83.0%(44/53) and 1/2 respectively, and there was significant difference(P=0.005 0). The multivariate analysis indicated that T stage (P=0.002 2, OR=3.741, 95% CI: 1.606-8.716) was the risk factor of intramural lateral spread.

CONCLUSIONSThe intramural lateral spread does exist in low rectal cancer and T stage is the risk factor of lateral spread. The lateral resection margin should be 5 mm from the tumor edge at least when PTCR is performed.

Digestive System Surgical Procedures ; methods ; Humans ; Margins of Excision ; Multivariate Analysis ; Neoplasm Invasiveness ; pathology ; Neoplasm Staging ; adverse effects ; Rectal Neoplasms ; pathology ; surgery ; Rectum ; surgery ; Risk Factors

Health Knowledge, Attitudes, Practice ; Humans ; Neoplasm Staging ; Risk Assessment ; methods ; Thyroid Diseases ; surgery ; Thyroid Neoplasms ; pathology ; surgery ; Thyroidectomy ; adverse effects ; methods

OBJECTIVETo analyze the causes and therapeutic approaches for the complications of radical hysterectomy plus pelvic lymphadenectomy in cervical cancer patients.

METHODSFrom Jan. 1995 to Dec. 2003, 219 such patients were treated by radical hysterectomy plus pelvic lymphadenectomy. The stages were: 26 stage IA (17 stage IA1 and 9 stage IA2) (11.9%); 142 stage IB (78 stage IB1, 64 stage IB2) (64.8%); 40 stage IIA (18.3%) and 3 stage IIB (1.4%). 204 patients in this series were treated by radical hysterectomy plus pelvic lymphadenectomy and 15 by modified radical hysterectomy with pelvic lymphadenectomy.

RESULTSa total of 49 patients (22.4%) developed postoperative complications. The major complications included: bladder dysfunction (10.0%); formation of lymphocysts (7.8%); wound infection (6.8%); hydronephrosis (1.4%) and formation of ureteral fistulas (0.5%). The patients in the group treated by radical hysterectomy plus pelvic lymphadenectomy was likely to develop postoperative complication compared with the patients in the group by modified radical hysterectomy plus pelvic lymphadenectomy (24.0% versus 0, P = 0.067). The postoperative complication incidence in the patients who had preoperative neoadjuvant chemotherapy through intra-arterial catheter or radical radiotherapy in the other hospitals were 50.0% (2/4) and 100.0% (1/1), which were higher than that of the patients treated primarily in our hospital (21.3%, 25.3%) though without statistically significant difference among the groups. Of 52 patients who had previous abdominal surgery history, 13 developed posoperative complications, there was no significant difference between the patients with or without previous abdominal surgery history. The complication incidence of 87 patients treated with preoperative afterloaded radiotherapy was higher than that of 124 patients primarily treated by surgery (25.3% versus 19.4%), but the difference between two groups was statistically not significant (P = 0.239).

CONCLUSIONThe complication of radical hysterectomy with pelvic lymphadenectomy is correlated with the surgery mode. Preoperative afterloaded radiotherapy may not increase postoperative complication incidence. Properly reducing the extent of surgery may decrease incidence of complications.

Adolescent ; Adult ; Aged ; Brachytherapy ; adverse effects ; Carcinoma, Squamous Cell ; pathology ; surgery ; Female ; Humans ; Hysterectomy ; adverse effects ; methods ; Lymph Node Excision ; Lymphocele ; etiology ; Middle Aged ; Neoplasm Staging ; Postoperative Complications ; Radiotherapy, Adjuvant ; adverse effects ; Urinary Retention ; etiology ; Uterine Cervical Neoplasms ; pathology ; surgery