Partial axillary dissection in early breast cancer

Background: In order to reduce the probability of later clinical involvement of the axilla and at establishing a sound basis for adjuvant treatment planning axillary dissection is an important operative procedure. So, partial axillary dissection has been applied to decrease the morbidity and postoperative axillary complications.Aim of the work was to study the reliability of partial axillary lymph node dissection in patients with breast carcinoma with clinically negative axilla. Methods: Eighteen patients underwent modified radical mastectomy, while the other two patients who were fulfilling the criteria for conservative breast surgery underwent lumpectomy. All patients did complete axillary lymph nodes dissection. Intraoperative leveling of the axilla was performed and level I axillary lymph nodes were identified according to their relation to pectoralis minor muscle; then they were subjected to intraoperative pathological examination by frozen section examination followed by complete axillary clearance. Then post operative histopathological examination of the tumor and all lymph nodes was done. Results: By intraoperative pathological examination; five patients (25%) were found positive for malignant invasion, while 15 patients (75%) were pathologically free. While paraffin section showed six patients (30%) with malignant invasion, and 14 patients (70%) were pathologically free. There was a false negative rate of 5% in level I axillary lymph nodes by intraoperative pathological examination which was positive for metastasis by paraffin section that revealed microinvasion in one lymph node out of 8 in level I. Only two cases out of 20 were found positive for metastasis in level II and III. Conclusion: Partial axillary lymph node dissection is a minimally invasive, feasible and sufficient technique that can predict the axillary lymph node status. KEYWORDS: Breast cancer, Axillary lymph nodes clearanc

The applicability of D2 gastrectomy in operable gastric cancer patients: A trial of Alexandria Surgical Oncology Unit

Background: There is ongoing controversy in patients with early gastric cancer over whether a lymph node resection beyond a D1 lymphadenectomy is beneficial. Experienced gastric surgery centers, especially in Japan and Korea, have argued that a more extensive lymph node dissection that incorporates the next echelon of lymph nodes (D2 lymphadenectomy) improves staging and outcome in gastric cancer patients. Aim of the work: Was to assess the feasibility and safety of D2 gastrectomy in patients presented by operable gastric cancer. Patients and Methods: The study included thirty patients with operable gastric cancer who were treated by D2 gastrectomy after preoperative assessment by laboratory and radiological investigations. They were followed post operatively for complications and hospital stay and the histopathological criteria were assessed and analyzed. Results: Twenty six patients had pyloric tumors and four having gastric body tumors were included. Postoperative complications occurred in 20% of cases, these included wound infection, bile leak, ascites and chest infection. Conclusion: D2 gastrectomy for gastric cancer is a safe procedure for patients with operable gastric cancer. KEYWORDS: Gastric cancer, D2 gastrectom