OBJECTIVE: To review the latest research advancements in surgical techniques for the treatment of limb lymphedema. METHODS: The relevant literature at home and abroad in recent years was extensively reviewed, and the research on the treatment of limb lymphedema by surgical techniques were summarized and analyzed. RESULTS: Lymphovenous anastomosis has demonstrated good effectiveness for early to mid-stage limb lymphedema, however its long-term effectiveness and applicability for late-stage limb lymphedema still require further validation. Autologous lymphatic/venous grafting has shown clinical feasibility in the treatment of secondary limb lymphedema. Research on tissue-engineered lymphatic scaffolds remains insufficient, primarily due to the complexity of lymphatic anatomical structures and the technical challenges involved. Nevertheless, its potential application is promising. Vascularized lymph node flap transplantation has shown significant effectiveness in treating limb lymphedema, particularly yielding good outcomes in upper limb cases. However, it can not guarantee a complete cure for the condition. Charles' operation is the most effective treatment option for patients with late-stage limb lymphedema, but its extensive incision and severe postoperative complications limit its application. Liposuction has the advantages such as minimal invasiveness, high safety, and repeatability. It is suitable for patients with late-stage limb lymphedema who have failed conservative treatment or developed adiposity. However, its effectiveness is limited in patients with significant limb fibrosis. CONCLUSION Current treatments for limb lymphedema require further improvement, and there is considerable debate regarding treatment strategies for different stages of the condition. Future high-quality, multi-system combined treatment approaches are anticipated to guide clinical practice.
Humans ; Lymphedema/surgery* ; Surgical Flaps/blood supply* ; Lymphatic Vessels/surgery* ; Anastomosis, Surgical/methods* ; Lymph Nodes/transplantation* ; Lipectomy/methods* ; Extremities/surgery* ; Treatment Outcome ; Tissue Engineering ; Tissue Scaffolds ; Veins/transplantation*

OBJECTIVE: To compare the effectiveness of single-stage vascularized lymph node transfer (VLNT) combined with lymphaticovenular anastomosis (LVA) and liposuction (LS) (3L) versus LVA combined with LS (2L) for the treatment of moderate-to-late stage upper limb lymphedema following breast cancer surgery. METHODS: A retrospective analysis was conducted on the clinical data of 16 patients with moderate-to-late stage upper limb lymphedema after breast cancer surgery, treated between June 2022 and June 2024, who met the selection criteria. Patients were divided into 3L group (n=7) and 2L group (n=9) based on the surgical approach. There was no significant difference (P>0.05) in baseline data between the groups, including age, body mass index, duration of edema, volume of liposuction, International Society of Lymphology (ISL) stage, preoperative affected limb volume, preoperative circumferences of the affected limb at 12 levels (from 4 cm distal to the wrist to 42 cm proximal to the wrist), preoperative Lymphoedema Quality of Life (LYMQoL) score, and frequency of cellulitis episodes. The 2L group underwent LS on the upper arm and proximal forearm and LVA on the middle and distal forearm. The 3L group received additional VLNT in the axilla, with the groin serving as the donor site. Outcomes were assessed included the change in affected limb volume at 12 months postoperatively, and comparisons of limb circumferences, LYMQoL score, and frequency of cellulitis episodes between preoperative and 12-month postoperative. Ultrasound evaluation was performed at 12 months in the 3L group to assess lymph node viability. RESULTS: Both groups were followed up 12-20 months, with an average of 15.13 months. There was no significant difference in the follow-up time between the groups (t=-1.115, P=0.284). All surgical incisions healed by first intention. No adverse events, such as flap infection or necrosis, occurred in the 3L group. At 12 months after operation, ultrasound confirmed good viability of the transferred lymph nodes in the 3L group. Palpation revealed significant improvement in skin fibrosis and improved skin softness in both groups. Affected limb volume significantly decreased in both groups postoperatively (P<0.05). The reduction in limb volume significantly greater in the 3L group compared to the 2L group (P<0.05). Circumferences at all 12 measured levels significantly decreased in both groups compared to preoperative values (P<0.05). The reduction in circumference at all 12 levels was better in the 3L group than in the 2L group, with significant differences observed at 7 levels (8, 12, 16, 30, 34, 38, and 42 cm) proximal to the wrist (P<0.05). Both groups showed significant improvement in the frequency of cellulitis episodes and LYMQoL scores postoperatively (P<0.05). While the improvement in LYMQoL scores at 12 months did not differ significantly between groups (P>0.05), the reduction in cellulitis episodes was significantly greater in the 3L group compared to the 2L group (P<0.05). CONCLUSION The combination of VLNT+LVA+LS provides more durable and comprehensive outcomes for moderate-to-late stage upper limb lymphedema after breast cancer surgery compared to LVA+LS, offering an improved therapeutic solution for patients.
Humans ; Female ; Lipectomy/methods* ; Retrospective Studies ; Anastomosis, Surgical/methods* ; Lymphedema/etiology* ; Middle Aged ; Upper Extremity/surgery* ; Breast Neoplasms/surgery* ; Lymph Nodes/blood supply* ; Adult ; Lymphatic Vessels/surgery* ; Iliac Artery/surgery* ; Postoperative Complications/surgery* ; Perforator Flap/blood supply* ; Treatment Outcome ; Mastectomy/adverse effects* ; Quality of Life ; Aged

BACKGROUND: Lung cancer has the highest mortality rate among all malignant tumors, and non-small cell lung cancer (NSCLC) accounts for about 80%-85% of all lung cancers. Lobectomy and lymph node dissection are one of the most important treatment methods, and lymph node dissection, as an important part, has attracted much attention. And its mode and scope of dissection may affect postoperative complications, particularly the occurrence of chronic cough. The aim of this study is to investigate the effect of lymph node dissection on postoperative chronic cough in patients with NSCLC undergoing lobectomy, and to provide clinical evidence for optimizing surgical strategy and reducing postoperative chronic cough. METHODS: A retrospective analysis was conducted on the clinical data of 365 NSCLC patients who underwent lobectomy at the First Affiliated Hospital of University of Science and Technology of China from December 2020 to December 2023. The relationship between clinical characteristics and postoperative chronic cough was analyzed. The Chinese version of the Leicester Cough Questionnaire (LCQ-MC) scores were collected from the patients at 2 time points: 1 day before surgery and 8 weeks after surgery. Patients were divided according to lymph node dissection methods, to explore the relationship between lymph node dissection and chronic cough after lobectomy. Additionally, patients were divided into chronic cough and non-chronic cough groups based on the presence of postoperative chronic cough, to investigate whether perioperative data, lymph node dissection methods, and lymph node dissection regions were influencing factors. RESULTS: Patients undergoing lobectomy were more likely to have chronic cough after surgery in the systematic lymph node dissection group than in the lymph node sampling group (P<0.05). LCQ-MC scale evaluation showed that the psychological, physiological, social and total score of the patients in systematic lymph node dissection group were significantly lower than those in lymph node sampling group (P<0.05). Multivariate analysis showed that anesthesia time, operation site, lymph node dissection method, whether to perform upper mediastinal lymph node dissection, number of upper mediastinal lymph node dissection, whether to perform lower mediastinal lymph node dissection and total number of lymph node dissection were independent risk factors for postoperative chronic cough in NSCLC patients (P<0.05). CONCLUSIONS When NSCLC patients underwent lobectomy, lymph node sampling was associated with a significantly lower risk of chronic cough than systematic lymph node dissection. Dissecting lymph nodes in the upper and lower mediastinal regions and the number of lymph nodes dissected may increase the risk of postoperative cough and reduce the quality of life of patients after surgery.
Humans ; Carcinoma, Non-Small-Cell Lung/surgery* ; Male ; Female ; Lung Neoplasms/surgery* ; Middle Aged ; Cough/etiology* ; Retrospective Studies ; Lymph Node Excision/methods* ; Aged ; Chronic Disease ; Postoperative Complications/etiology* ; Adult ; Lymph Nodes/surgery* ; Pneumonectomy/adverse effects* ; Chronic Cough

Objective:To investigate the clinical efficacy of robotic surgery via the bilateral axillo-breast approach（BABA） in lateral lymph node dissection for papillary thyroid carcinoma（PTC）. Methods:Clinicopathological records of 324 PTC patients receiving unilateral neck dissection in Tianjin Medical University Cancer Institute and Hospital from December 2020 to November 2024 were retrospectively analyzed. Of these patients, 108 underwent robotic surgery via BABA（robotic group）, while the remaining patients underwent conventional open surgery（open group）. The extent of lateral neck lymph node dissection included level Ⅱ, Ⅲ and Ⅳ. The differences in surgical indexes, postoperative complication rates and cosmetic outcomes of incisions were compared between two groups. Results:All study subjects completed the operation successfully, and there was no conversion in the robotic group. The average age of patients in the robotic group was lower than that in the open group, and the proportion of female patients was higher in the robotic group compared to the open group（P<0.05）. Patients in the robotic group had a greater number of dissected lymph nodes in level ⅡB and higher cosmetic scores（P<0.05）. There were no statistically significant differences between the two groups in the average dissection time of lateral cervical lymph nodes, the number of dissected lymph nodes and metastatic lymph nodes in level ⅡA, Ⅲ, and Ⅳ, average postoperative drainage volume, average postoperative hospital stay, and postoperative complication rates（P>0.05）. Conclusion:The application of robotic surgical system via BABA in lateral neck lymph node dissection for PTC is safe and feasible, with superior advantages in level ⅡB dissection and better postoperative cosmetic outcomes.
Humans ; Thyroid Neoplasms/surgery* ; Robotic Surgical Procedures/methods* ; Female ; Retrospective Studies ; Neck Dissection/methods* ; Lymph Node Excision/methods* ; Male ; Thyroid Cancer, Papillary ; Axilla/surgery* ; Thyroidectomy/methods* ; Breast/surgery* ; Middle Aged ; Adult ; Lymph Nodes/surgery* ; Treatment Outcome

Thermal ablation has proven an effective treatment modality for certain thyroid diseases. However, its indications remain the subject of significant debate both domestically and internationally. Over recent years, several international academic organizations have issued consensus statements, position papers, and guidelines concerning thyroid thermal ablation. In China, the Chinese College of Interventionalists (CCI), in collaboration with other relevant academic organizations, released the "Expert consensus on thermal ablation for thyroid benign nodes, microcarcinoma and metastatic cervical lymph nodes (2018 edition)". This consensus statement received widespread recognition within the field and contributed significantly to the standardization of thyroid thermal ablation therapy in China. With the continuous accumulation of evidence-based medical data, the need for a more stringent and standardized approach to thyroid thermal ablation has become evident. Accordingly, the Interventional Ultrasound Committee of the CCI, in collaboration with multiple academic organizations and experts, conducted extensive discussions and multiple revisions before finalizing the "Multidisciplinary expert consensus on thermal ablation for benign thyroid diseases, low-risk thyroid carcinoma, and metastatic cervical lymph nodes (2025 edition)". This updated consensus builds on the framework of the 2018 edition, refining indications and contraindications, emphasizing standardized treatment, and outlining future directions for research and clinical applications of thyroid thermal ablation technology.
Humans ; Thyroid Neoplasms/surgery* ; Consensus ; Lymphatic Metastasis ; Lymph Nodes/pathology* ; Thyroid Diseases/surgery*

OBJECTIVE: To explore the clinical significance of extended pelvic lymph node dissection (EPLND) under the robot-assisted laparoscope in the treatment of high-risk PCa. METHODS: This study included 29 cases of high-risk PCa treated by robot-assisted laparoscopic radical prostatectomy and EPLND from April 2020 to January 2023. We collected the general data on the patients, recorded the status of dissection of the lymph nodes and postoperative complications, and analyzed the significance of EPLND. RESULTS: The patients were aged (69.3±6.6) years old, with the preoperative PSA level of 8.43－434 μg/L, Gleason score (GS) 6 in 1, GS 7 in 9, and GS ≥8 in 19 cases. The operation time averaged (97.2±15.7) min, with the mean blood loss of (30.5±11.2) ml, and 3－42 (median = 13) lymph nodes dissected, less than 10 in 10 cases, 11－19 in 12, and more than 20 in 7. Positive pelvic lymph nodes (median = 4) were found in 13 cases, with a positive rate of 44.8%. Positive incisal margin was observed in 11 cases (37.9%), lymphovascular invasion (LVI) in 4 (13.8%), and perineural invasion (PNI) in another 4 (13.8%). Lymph node metastasis was significantly correlated with positive incisal margin (P<0.05), but not with LVI, PNI or age (P>0.05). No significant vascular or nerve injuries occurred during the operation. GS 6 was detected in 1, GS 7 in 7, and GS ≥8 in 21 cases postoperatively. CONCLUSION Robot-assisted laparoscopic EPLND is an important strategy for the treatment of high-risk PCa, which contributes to accurate pathological staging of the malignancy. However, evidence is lacking for its benefit to the survival of high-risk PCa patients, and more follow-up studies are needed to confirm its treatment effect.
Humans ; Male ; Lymph Node Excision/methods* ; Prostatic Neoplasms/pathology* ; Laparoscopy/methods* ; Robotic Surgical Procedures ; Aged ; Prostatectomy/methods* ; Pelvis ; Lymphatic Metastasis ; Lymph Nodes/surgery* ; Middle Aged

Sentinel lymph nodes (SLNs) are the first station of lymph nodes that extend from the breast tumor to the axillary lymphatic drainage. The pathological status of these LNs can predict that of the entire axillary lymph node. Therefore, the accurate identification of SLNs is necessary for sentinel lymph node biopsy (SLNB) to replace axillary lymph node dissection (ALND). The quality of life and prognosis of breast cancer patients are related to proper surgical treatment after the precise identification of SLNs. Some of the SLN tracers that have been identified include radioisotope, nano-carbon, indocyanine green (ICG), and methylene blue (MB). However, these tracers have certain limitations, such as pigmentation, radiation dangers, and the requirement for costly detection equipment. Ultrasound contrast agents (UCAs) have good specificity and sensitivity, and thus can compensate for some shortcomings of the mentioned tracers. This technique is also being applied to SLNB in patients with breast cancer, and can even provide an initial judgment on SLN status. Contrast-enhanced ultrasound (CEUS) has the advantages of high distinguishability, simple operation, no radiation harm, low cost, and accurate localization; therefore, it is expected to replace the traditional biopsy methods. In addition, it can significantly enhance the accuracy of SLN localization and shorten the operation time.
Humans ; Female ; Sentinel Lymph Node/pathology* ; Breast Neoplasms/pathology* ; Quality of Life ; Sentinel Lymph Node Biopsy/methods* ; Ultrasonography/methods* ; Lymph Nodes/surgery*

A case of laryngeal cancer complicated with Hodgkin's lymphoma treated in the Department of Otolaryngology Head and neck surgery of the First Hospital of Jilin University was reported. Under general anesthesia, right vertical partial laryngectomy, bilateral neck lymph node functional dissection and temporary tracheotomy were performed. No recurrence was found in laryngoscope and color Doppler ultrasound of neck lymph nodes 3 and 5 months after operation.
Humans ; Laryngeal Neoplasms/surgery* ; Hodgkin Disease/complications* ; Neck/pathology* ; Neck Dissection ; Lymph Nodes/pathology* ; Laryngectomy ; Carcinoma/pathology*

Objective:To investigate the correlation between preoperative platelet parameters and the clinicopathological features of differentiated thyroid cancer. Methods:We retrospectively analyzed the medical records of patients with thyroid tumors admitted to Zhongda Hospital affiliated to Southeast University and healthy adults with normal physical examination results in our hospital from January 2019 to December 2020, and collected their general information and preoperative blood routine data. Patients with undifferentiated thyroid cancer, diabetes, coronary heart disease, hematological diseases, kidney diseases, autoimmune diseases, genetic diseases, infectious diseases, other systemic tumors, hepatitis or cirrhosis, or those taking anticoagulants were excluded. The exclusion criteria for healthy adults were the absence of the above diseases and normal physical examination results. Differences in platelet parameters among the three groups were compared, and the correlation between clinicopathological characteristics of thyroid cancer, accompanying cervical lymph node metastasis, and platelet parameters of patients was analyzed. A multivariate logistic regression model was used to analyze the risk factors of thyroid cancer with cervical lymph node metastasis. Results:A total of 117 cases of differentiated thyroid cancer were collected, including 33 males and 84 females, with an average age of （41.64±12.25） years; 46 patients had benign thyroid tumors, including 15 males and 31 females, with an average age of （41.35±12.52） years; 50 healthy adults with normal physical examination results in our hospital during the same period were also included, including 18 males and 32 females, with an average age of（42.02±9.62） years, without underlying diseases. The platelet count of the differentiated thyroid cancer group was higher than that of the benign thyroid tumor group（t=-2.219, P=0.028） and the normal control group（t=2.069, P=0.04）, while the platelet distribution width of the differentiated thyroid cancer group was lower than that of the benign thyroid tumor group（t=2.238, P=0.027） and the normal control group（t=-2.618, P=0.002）. These differences were statistically significant. Preoperative age ≤45 years（χ²=4.225, P=0.04）, tumor diameter>1 cm（χ²=4.415, P=0.036）, PLT（t=-4.018, P<0.01） increase, and PDW（t=4.568, P<0.01） decrease were significantly correlated with cervical lymph node metastasis of thyroid cancer and had statistical significance. Univariate analysis showed that age ≤45 years（OR=0.447, 95%CI 0.206-0.970, P=0.042）, tumor diameter>1 cm（OR=2.3, 95%CI 1.050-5.039, P=0.037）, PLT（OR=1.012, 95%CI 1.005-1.019, P=0.001）, and PDW（OR=0.693, 95%CI 0.518-0.827, P<0.01） were risk factors for cervical lymph node metastasis of thyroid cancer. The results of multifactorial logistic regression analysis showed that PLT（OR=1.008, 95%CI 1.001-1.016, P=0.026） and PDW（OR=0.692, 95%CI 0.564-0.848, P<0.01） were independent risk factors for thyroid cancer with cervical lymph node metastasis. Conclusion:PLT and PDW may be useful predictive factors for the differentiation of thyroid cancer malignancy and central lymph node metastasis.
Adult ; Male ; Female ; Humans ; Middle Aged ; Lymphatic Metastasis/pathology* ; Retrospective Studies ; Thyroid Neoplasms/surgery* ; Neck/pathology* ; Lymph Nodes/pathology* ; Adenocarcinoma

Early colorectal cancers refer to invasive cancers that have infiltrated into the submucosa without invading muscularis propria, and approximately 10% of these patients have lymph node metastases that cannot be detected by conventional imaging. According to the guidelines of Chinese Society of Clinical Oncology (CSCO) Colorectal Cancer, early colorectal cancer cases with risk factors for lymph node metastasis (poor tumor differentiation, lymphovascular invasion, deep submucosal invasion and high-grade tumor budding) should receive salvage radical surgical resection; however, the specificity of this risk-stratification is inadequate, making most patients undergo unnecessary surgery. Firstly, this review focuses on the definition, oncological impact importance and controversy of the above "risk factors". Then, we introduce the progress of the risk stratification system for lymph node metastasis in early colorectal cancer, including the identification of new pathological risk factors, the construction of new risk quantitative models based on pathological risk factors, artificial intelligence and machine learning technology and the discovery of novel molecular markers associated with lymph node metastasis based on gene test or liquid biopsy. Aim to enhance clinicians' understanding of the risk assessment of lymph node metastasis in early colorectal cancer; we suggest to take the patient's personal situation, tumor location, anti-cancer intention and other factors into account to make individualized treatment strategies.
Humans ; Lymphatic Metastasis/pathology* ; Artificial Intelligence ; Colorectal Neoplasms/surgery* ; Risk Factors ; Risk Assessment ; Neoplasm Invasiveness ; Lymph Nodes/pathology*