18,733 research outputs found
Prostate lymphoscintigraphy and radio-guided surgery for sentinel lymph node identification in prostate cancer - Technique and results of the first 350 cases
Introduction: Having in mind the promising results of lymphoscintigraphy and intraoperative gamma probe application for the detection of sentinel lymph nodes (SLN) in malignant melanoma, breast and penis cancer, we tried to identify the SLN in prostate cancer by applying a comparable technique. Materials and Method. 350 patients with prostate cancer were examined after providing informed consent. The day before pelvic lymphadenectomy technetium-99m nanocolloid was transrectally injected into the prostate under ultrasound guidance. A single central application was done per prostate lobe in most cases. Activity attained 90400 MBq, and the total injected volume was about 2-3 ml. Hereafter, lymphoscintigraphy was carried out. Those lymph nodes having been identified as SLN by means of gamma probe detection and lymphoscintigraphy were removed intraoperatively. Later, most of the cases had different types of pelvic lymphadenectomy. SLN received serial sections and immunohistochemistry, non-SLN step sections. Results: 335 patients showed at least 1 SLN in lymphoscintigraphy. 24.7% had lymph node metastases. In 2 patients, metastases in non-SLN were found without at least one SLN being affected (false-negative patient). Conclusion:Our experience suggests that the SLN identification is not only feasible in breast cancer and malignant melanoma, but also in prostate cancer with a comparable technique. Copyright (C) 2003 S. Karger AG, Basel
Morbidity following Surgical Management of Vulval Cancer.
The objective of this study was to know the complications following vulvectomy and inguinofemoral lymphadenectomy including the time taken to complete wound healing. 42 patients who were subjected to either radical or modified radical vulvectomy for primary and inguinofemoral lymphadenectomy (80 groins) for groin metastases were analysed retrospectively. The complications analysed were wound breakdown, wound cellulitis or infection, lymphocyst, limb edema and the time to wound healing. In a total of 80 inguinofemoral lymphadenectomies 55% had wound breakdown, 17.5% had wound infection/cellulitis, lymphocyst in 31%, limb edema in 36% and time taken for complete wound healing ranged from 10-134 (average 46 days). Overall post operative morbidity was 85%
The esophagogastric junctional adenocarcinoma an increasing disease
Identifying and defining the esophagogastric junctional adenocarcinoma (EGJA) as an independent disease apart from gastric cancer (GC) and esophagus cancer (EG) it has always been a difficult issue entailing doubts about the appropriate therapeutic approach
The Impact of the Extent of Lymphadenectomy on Oncologic Outcomes in Patients Undergoing Radical Cystectomy for Bladder Cancer : A Systematic Review
Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.Peer reviewedPostprin
Para-aortic node involvement is not an independent predictor of survival after resection for pancreatic cancer
AIM
To analyze the importance of para-aortic node status in a series of patients who underwent pancreaticoduodenectomy (PD) in a single Institution.
METHODS
Between January 2000 and December 2012, 151 patients underwent PD with para-aortic node dissection for pancreatic adenocarcinoma in our Institution. Patients were divided into two groups: patients with negative PALNs (PALNs-), and patients with metastatic PALNs (PALNs+). Pathologic factors, including stage, nodal status, number of positive nodes and lymph node ratio, invasion of para-aortic nodes, tumor\u2019s grading, and radicality of resection were studied by univariate and multivariate analysis. Survival curves were constructed with Kaplan-Meier method and compared with Log-rank test: significance was considered as P < 0.05.
RESULTS
A total of 107 patients (74%) had nodal metastases. Median number of pathologically assessed lymph nodes was 26 (range 14-63). Twenty-five patients (16.5%) had para-aortic lymph node involvement. Thirty-three patients (23%) underwent R1 pancreatic resection. One-hundred forty-one patients recurred and died for tumor recurrence, one is alive with recurrence, and 9 are alive and free of disease. Overall survival was significantly influenced by grading (P = 0.0001), radicality of resection (P = 0.001), stage (P = 0.03), lymph node status (P = 0.04), para-aortic nodes metastases (P = 0.02). Multivariate analysis showed that grading was an independent prognostic factor for overall survival (P = 0.0001), while grading (P = 0.0001) and radicality of resection (P = 0.01) were prognostic parameters for disease-free survival. Number of metastatic nodes, node ratio, and para-aortic nodes involvement were not independent predictors of disease-free and overall survival.
CONCLUSION
In this experience, lymph node status and para-aortic node metastases were associated with poor survival at univariate analysis, but they were not independent prognostic factors
Triple peptide vaccination as consolidation treatment in women affected by ovarian and breast cancer: clinical and immunological data of a phase I/II clinical trial
Vaccination with priming and expansion of tumour
reacting T cells is an important therapeutic option to be used
in combination with novel checkpoint inhibitors to increase
the specificity of the T cell infiltrate and the efficacy of the
treatment. In this phase I/II study, 14 high-risk disease-free
ovarian (OC) and breast cancer (BC) patients after completion
of standard therapies were vaccinated with MUC1, ErbB2
and carcinoembryonic antigen (CEA) HLA-A2+-restricted
peptides and Montanide. Patients were subjected to 6 doses
of vaccine every two weeks and a recall dose after 3 months.
ECOG grade 2 toxicity was observed at the injection site. Eight
out of 14 patients showed specific CD8+ T cells to at least one
antigen. None of 4 patients vaccinated for compassionate use
showed a CD8 activation. An OC patient who suffered from
a lymph nodal recurrence, showed specific anti-ErbB2 CD8+
T cells in the bulky aortic lymph nodes suggesting homingof the activated T cells. Results confirm that peptide vaccination
strategy is feasible, safe and well tolerated. In particular
OC patients appear to show a higher response rate compared
to BC patients. Vaccination generates a long-lasting immune
response, which is strongly enhanced by recall administrations.
The clinical outcome of patients enrolled in the trial
appears favourable, having registered no deceased patients
with a minimum follow-up of 8 years. These promising data,
in line with the results of similar studies, the high compliance
of patients observed and the favourable toxicity profile, support
future trials of peptide vaccination in clinically disease-free
patients who have completed standard treatments
Robotic total gastrectomy with intracorporeal robot-sewn anastomosis. A novel approach adopting the double-loop reconstruction method
Gastric cancer constitutes a major health problem. Robotic
surgery has been progressively developed in this field. Although the
feasibility of robotic procedures has been demonstrated, there are
unresolved aspects being debated, including the reproducibility of
intracorporeal in place of extracorporeal anastomosis.
Difficulties of traditional laparoscopy have been described and there
are well-known advantages of robotic systems, but few articles in
literature describe a full robotic execution of the reconstructive phase
while others do not give a thorough explanation how this phase was run.
A new reconstructive approach, not yet described in literature, was
recently adopted at our Center.
Robotic total gastrectomy with D2 lymphadenectomy and a socalled
ââdouble-loopââ reconstruction method with intracorporeal robotsewn
anastomosis (Parisiâs technique) was performed in all reported
cases.
Preoperative, intraoperative, and postoperative data were collected
and a technical note was documented.
All tumors were located at the upper third of the stomach, and no
conversions or intraoperative complications occurred. Histopathological
analysis showed R0 resection obtained in all specimens. Hospital
stay was regular in all patients and discharge was recommended starting
from the 4th postoperative day. No major postoperative complications
or reoperations occurred.
Reconstruction of the digestive tract after total gastrectomy is one of
the main areas of surgical research in the treatment of gastric cancer and
in the field of minimally invasive surgery.
The double-loop method is a valid simplification of the traditional
technique of construction of the Roux-limb that could increase the
feasibility and safety in performing a full hand-sewn intracorporeal
reconstruction and it appears to fit the characteristics of the robotic
system thus obtaining excellent postoperative clinical outcome
Morbidity after surgical management of cervical cancer in low and middle income countries: A systematic review and meta-analysis
Objective: To investigate morbidity for patients after the primary surgical management of cervical cancer in low and middle-income countries (LMIC).
Methods: The Pubmed, Cochrane, the Cochrane Central Register of Controlled Trials, Embase, LILACS and CINAHL were searched for published studies from 1st Jan 2000 to 30th June 2017 reporting outcomes of surgical management of cervical cancer in LMIC. Randomeffects meta-analytical models were used to calculate pooled estimates of surgical complications including blood transfusions, ureteric, bladder, bowel, vascular and nerve injury, fistulae and thromboembolic events. Secondary outcomes included five-year progression free (PFS) and overall survival (OS).
Findings: Data were available for 46 studies, including 10,847 patients from 11 middle income countries. Pooled estimates were: blood transfusion 29% (95%CI 0.19â0.41, P = 0.00, I 2 = 97.81), nerve injury 1% (95%CI 0.00â0.03, I 2 77.80, P = 0.00), bowel injury, 0.5% (95%CI 0.01â0.01, I 2 = 0.00, P = 0.77), bladder injury 1% (95%CI 0.01â0.02, P = 0.10, I 2 = 32.2), ureteric injury 1% (95%CI 0.01â0.01, I 2 0.00, P = 0.64), vascular injury 2% (95% CI 0.01â 0.03, I 2 60.22, P = 0.00), fistula 2% (95%CI 0.01â0.03, I 2 = 77.32, P = 0.00,), pulmonary embolism 0.4% (95%CI 0.00â0.01, I 2 26.69, P = 0.25), and infection 8% (95%CI 0.04â0.12, 2 95.72, P = 0.00). 5-year PFS was 83% for laparotomy, 84% for laparoscopy and OS was 85% for laparotomy cases and 80% for laparoscopy.
Conclusion: This is the first systematic review and meta-analysis of surgical morbidity in cervical cancer in LMIC, which highlights the limitations of the current data and provides a benchmark for future health services research and policy implementation
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