Effect of Surgical Approach on Node Harvest in Robotic Gastrectomy

2019 ◽  
Vol 85 (8) ◽  
pp. 794-799
Author(s):  
Michael D. Watson ◽  
Sally J. Trufan ◽  
Nicole L. Gower ◽  
Joshua S. Hill ◽  
Jonathan C. Salo
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Gastric Adenocarcinoma ◽  
Surgical Approach ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Laparoscopic Approach ◽  
Robotic Gastrectomy ◽  
Robotic Approach ◽  
Lymph Node Harvest

There has been increasing utilization of minimally invasive surgical approaches. This study evaluates the effect of surgical approach on total lymph node harvest in gastrectomy. Patients undergoing gastrectomy for gastric adenocarcinoma between 2007 and 2018 were reviewed retrospectively. Data collected included age, gender, race, BMI, neoadjuvant therapy, tumor stage, surgical approach, and total number of lymph nodes harvested. The total number of harvested lymph nodes for open, laparoscopic, and robotic gastrectomy was compared using the Kruskal-Wallis test for univariate analysis and a Poisson regression model for multivariable analysis. One hundred four patients were identified. Median node harvest for open, laparoscopic, and robotic approaches were 16, 17, and 36, respectively. Multivariable analysis controlling for gender, BMI, pathological T stage, and year of operation demonstrates that surgical approach is statistically significantly associated with lymph node harvest ( F = 83.4, P < 0.0001). In multivariable analysis, robotic approach was associated with greater lymph node harvest than both open ( P < 0.0001) and laparoscopic ( P < 0.0001) approaches, whereas laparoscopic approach was associated with greater lymph node harvest than open ( P < 0.0001) approach. These data demonstrate that for patients undergoing gastrectomy for gastric adenocarcinoma at our institution, robotic approach is associated with greater lymph node harvest than both laparoscopic and open approaches.

scholarly journals Insufficient lymph node assessment in gastric adenocarcinoma

2019 ◽  
Vol 31 (1) ◽  
Author(s):  
Nezhat Khanjani ◽  
Sepideh Mirzaei ◽  
Hamid Nasrolahi ◽  
Seyed Hasan Hamedi ◽  
Ahmad Mosalaei ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Gastric Adenocarcinoma ◽  
Perineural Invasion ◽  
Univariate Analysis ◽  
Neoadjuvant Treatment ◽  
Primary Tumor Size ◽  
Lymph Node Assessment ◽  
Lymph Node Examination ◽  
Type Of Surgery

Abstract Background This study aimed to investigate the sufficient (≥ 16) lymph node assessment in 449 patients with gastric adenocarcinoma and literature review. Methods Four hundred and forty-nine patients with pathologically confirmed locoregional invasive gastric adenocarcinoma from 2004 to 2013 were included. A standard surgical resection was performed for all the patients with (n = 16) or without (n = 433) neoadjuvant treatment. Results In this study, 301 men and 148 women with a median age of 58 (range 21–88) years were included. The median total numbers of examined lymph nodes were 9 (range 0–55). Ninety-five patients (21.2%) had adequate (≥ 16) lymph node examination, and 70 patients (15.6%) had no examined lymph nodes. In univariate analysis, total or near total gastrectomy (P <  0.001), advanced node stage (P < 0.001), primary tumor size > 6 cm (P < 0.001), and the presence of perineural invasion (P = 0.039) were associated with more average number of examined lymph nodes. On multivariate analysis, node stage (P < 0.001) and type of surgery (P = 0.008) were independent predictive factors. Conclusion In this study, approximately one in five patients with gastric adenocarcinoma had sufficient lymph node assessment. More studies are suggested for identifying a true inadequate lymph node dissection from insufficient lymph node assessment.

scholarly journals Risk factors for central lymph node metastasis in the cervical region in papillary thyroid carcinoma: a retrospective study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Xiang Li ◽  
Hanwen Zhang ◽  
Yu Zhou ◽  
Ruochuan Cheng
Keyword(s):  
Risk Factors ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Vascular Invasion ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Cervical Region ◽  
Tumor Diameter ◽  
Central Lymph Node ◽  
Central Lymph

Abstract Background To investigate the influence of different risk factors on central lymph node metastasis (CLNM) in the cervical region in patients with papillary thyroid carcinoma (PTC). Methods This retrospective study included 2586 PTC patients. Potential risk factors were identified by univariate analysis, and the relationships between these factors and CLNM were ascertained by multivariable analysis. A scoring system was constructed, and the optimal cut-off value was determined. Results On univariate analysis, sex, age, tumor diameter, multifocality, capsule invasion, vascular invasion, total number of lymph nodes in the central region, and serum thyroid peroxidase antibody (TPOAb) concentration were identified as potential risk factors for CLNM in the cervical region, whereas nerve invasion, thyroid-stimulating hormone concentration, and thyroglobulin antibody (TgAb) concentration were not. Multivariable analysis indicated that male sex, young age, large tumor diameter, multifocality, vascular invasion, a large number of central lymph nodes, and a low TPOAb concentration were significant risk factors. From these factors, a preoperative CLNM risk assessment scale was constructed for predicting CLNM in the cervical region for PTC patients. Conclusion Male sex, young age, large tumor diameter, multifocality, vascular invasion, a large number of central lymph nodes, and a low TPOAb concentration were positively correlated with CLNM in the cervical region in PTC patients. The preoperative CLNM risk assessment scale based on these risk factors is expected to offer accurate preoperative assessment of central lymph node status in PTC patients.

scholarly journals The presence of metastases in regional lymph nodes is associated with tumor size and depth of invasion in sporadic gastric adenocarcinoma

2014 ◽  
Vol 27 (1) ◽  
pp. 18-21 ◽  
Author(s):  
Eduardo CAMBRUZZI ◽  
Andreza Mariane de AZEREDO ◽  
Ardala KRONHART ◽  
Katia Martins FOLTZ ◽  
Cláudio Galeano ZETTLER ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Gastric Adenocarcinoma ◽  
Tumor Size ◽  
Perineural Invasion ◽  
Histological Grade ◽  
Lymph Node Status ◽  
Depth Of Invasion ◽  
Tumor Spread ◽  
Signet Ring

Background: Gastric adenocarcinoma is more often found in men over 50 years in the form of an antral lesion. The tumor has heterogeneous histopathologic features and a poor prognosis (median survival of 15% in five years). Aim: To estimate the relationship between the presence of nodal metastasis and other prognostic factors in sporadic gastric adenocarcinoma. Method: Were evaluated 164 consecutive cases of gastric adenocarcinoma previously undergone gastrectomy (partial or total), without clinical evidence of distant metastasis, and determined the following variables: topography of the lesion, tumor size, Borrmann macroscopic configuration, histological grade, early or advanced lesions, Lauren histological subtype, presence of signet ring cell, degree of invasion, perigastric lymph node status, angiolymphatic/perineural invasion, and staging. Results: Were found 21 early lesions (12.8%) and 143 advanced lesions (87.2%), with a predominance of lesions classified as T3 (n=99/60, 4%) and N1 (n=62/37, 8%). The nodal status was associated with depth of invasion (p<0.001) and tumor size (p<0.001). The staging was related to age (p=0.048), histological grade (p=0.003), and presence of signet ring cells (p = 0.007), angiolymphatic invasion (p = 0.001), and perineural invasion (p=0.003). Conclusion: In gastric cancer, lymph node involvement, tumor size and depth of invasion are histopathological data associated with the pattern of growth/tumor spread, suggesting that a wide dissection of perigastric lymph nodes is a fundamental step in the surgical treatment of these patients.

Role of adjuvant therapy after R0 resection for patients with distal cholangiocarcinoma.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 355-355
Author(s):  
Young Saing Kim ◽  
In Gyu Hwang ◽  
Song-ee Park ◽  
Eun Young Kim ◽  
Jung Hun Kang ◽  
...  
Keyword(s):  
Lymph Node ◽  
Adjuvant Therapy ◽  
Lymph Nodes ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards Model ◽  
Lymph Node Status ◽  
R0 Resection ◽  
Distal Cholangiocarcinoma ◽  
Positive Lymph Nodes

355 Background: There is still debated regarding the optimal treatment strategy in cholangiocarcinoma after curative resection. The aim of this study was to analyze the role of adjuvant therapy in R0-resected distal cholangiocarcinoma. Methods: We retrospectively reviewed the medical records of patients who underwent R0 resection for distal cholangiocarcinoma between January 2001 and December 2013 at six cancer centers in Korea. Adjuvant therapy consisted of chemotherapy (CT), chemoradiotherapy (CRT), or radiotherapy (RT). Multivariable Cox proportional hazards model was used to identify prognostic factors for overall survival (OS). Results: A total of 158 patients were included in the analysis; 47 patients (29.7%) had lymph node involvement. Fifty-six patients (35.4%) received adjuvant therapy (CT/CRT/RT: 27/20/9, respectively). Patients with advanced TNM stage (p = 0.001), T3/T4 disease (p = 0.009), positive lymph nodes (p = 0.052) and elevated CA 19-9 (p = 0.071) were more likely to receive adjuvant therapy. The effect of adjuvant therapy varied according to the treatment modality. Multivariable analysis showed a significant improvement in OS with CRT (Hazard ratio (HR) 0.25, 95% CI 0.08-0.83, p = 0.024) and CT (HR 0.21, 95% CI 0.08-0.53, p = 0.001). However, RT alone was associated with shorter OS (HR 2.38, p = 0.040), along with T3/T4 disease (HR 2.12, p = 0.012) and positive lymph nodes (HR 2.30, p = 0.008). In the subset analysis according to lymph node status, adjuvant therapy not including RT alone was associated with a significant OS advantage both in node-negative patients (median, 103.3 vs. 54.9 months, p = 0.037) and node-positive patients (not reached vs. 22.6 months, p = 0.013). Conclusions: Our results showed that patients receiving adjuvant CT or CRT had significant improvement in OS. In addition, the benefit of adjuvant therapy (except RT alone) was observed even in patients with negative lymph nodes.

Impact of robotic-assisted approach on lymphadenectomy for colorectal cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 787-787
Author(s):  
Reza Gamagami ◽  
Paul Kozak ◽  
Venkata R. Kakarla
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Laparoscopic Surgery ◽  
Lymph Nodes ◽  
Demographic Data ◽  
Robotic Assisted ◽  
Lymph Node Harvest ◽  
Significant Difference ◽  
The Mean ◽  
The Impact

787 Background: In most recent years, robotic assisted laparoscopic surgery (RALS) has proven to be a viable alternative to laparoscopic and traditional open surgery for colorectal cancer. Obtaining the adequate number of lymph nodes is not only essential for accurate staging, but also impacts both prognosis and the need for adjuvant chemotherapy. To date, the efficacy of lymph node harvest for RALS is not well studied or established. The aim of our study is to analyze the impact of RALS on lymphadenectomy for colorectal cancer. Methods: We performed a retrospective review of patients who underwent curative resections for colorectal cancer over a five-year period at a single institution by a single surgeon. Resections were classified as right-sided, sigmoid, or rectal, and subdivided into robotic and non-robotic surgery groups. The demographic data and histopathology were obtained, with an emphasis on the number lymph nodes harvested (LNH) during resections. Emergencies and non-curative resections were excluded. Results: Between January 2010 and December 2015, 136 patients with colorectal cancer underwent curative resections. Sixty-four underwent right-sided resections (28 laparoscopic, 36 robotic). Twenty-five underwent sigmoid resections (11 laparoscopic, 14 robotic), and 47 underwent rectal resections (15 open, 32 robotic). There was no significant difference in age, sex, BMI and ASA scores between the cohorts examined. The mean number of LNH with RALS was significantly higher in all three groups (right-sided—24 vs. 15 ( p= .0001), sigmoid—16 vs. 12 ( p= .046), rectal—19 vs. 4 ( p= .0016)). There was no difference in the rate of adequate lymph node extraction for staging purpose, i.e., 12 lymph nodes in all three groups. Conclusions: Robotic-assisted laparoscopic surgery is associated with a statistically significant increase in lymph node harvest for right-sided, sigmoid and rectal resections for malignancy. Future studies with larger sample sizes are necessary to validate these findings.

PET-CT Gamma Probe-Guided Lymph Node Biopsy: A New Diagnostic Surgical Approach

2017 ◽  
Vol 103 (1_suppl) ◽  
pp. S34-S36
Author(s):  
Antonio Piñero-Madrona ◽  
Jorge Luis Monserrat-Coll ◽  
José Ruiz-Pardo ◽  
Juan Cabezas-Herrera ◽  
Francisco Nicolás-Ruiz
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Surgical Approach ◽  
Gamma Probe ◽  
Ct Images ◽  
Lymph Node Biopsy ◽  
Diagnostic Tools ◽  
Biopsy Technique ◽  
Node Biopsy ◽  
Pet Ct

Purpose The higher sensitivity of new diagnostic tools makes it easier to detect relapse in asymptomatic stages when classic procedures of lymph node biopsies are difficult to perform. The aim of this article is to describe the combination of gamma probe and 18F-FDG positron emission tomography-computed tomography (PET-CT) images in combination with sentinel lymph node biopsy technique for detection of nonpalpable lymph nodes. Methods After a dose of 18F-FDG was administered and PET-CT images that showed the location of suspected pathologic lymph nodes were obtained, transcutaneous localization of the lymph nodes with the highest captation of the tracer was done. The gamma probe was programmed to detect the radioactive signal from the F18, instead of the Tc99m that is usual in the sentinel node biopsy technique. Once the hottest point was detected, a short incision was made on this area, and suspicious nodes with the highest uptake registered by the gamma probe were localized and removed. After the surgical removal from the operating field, the surgical pieces stood positive to the gamma probe. Lymph node involvement, and subsequent relapse, was diagnosed before their clinical manifestation. Conclusions This methodology confirms new horizons for the surgical approach of lymph node biopsies in patients with previous tumors with 18F-FDG avidity and suspicion of relapse.

Does Obesity Influence Lymph Node Harvest among Patients Undergoing Colectomy for Colon Cancer?

2008 ◽  
Vol 74 (11) ◽  
pp. 1073-1077 ◽  
Author(s):  
Amir A. Damadi ◽  
Lucas Julien ◽  
Rodrigo Arrangoiz ◽  
Manish Raiji ◽  
David Weise ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Correlation Coefficients ◽  
Sigmoid Colectomy ◽  
Obese Patients ◽  
Lymph Node Harvest ◽  
Significant Difference ◽  
The Mean ◽  
Nonobese Patients

Adequate lymph node harvest among patients undergoing colectomy for cancer is critical for staging and therapy. Obesity is prevalent in the American population. We investigated whether lymph node harvest was compromised in obese patients undergoing colectomy for cancer. Medical records of patients who had undergone colectomy for colon cancer were reviewed. We correlated the number of lymph nodes with body mass index (BMI) and compared the number of lymph nodes among patients with BMI less than 30 kg/m2 to those with BMI of 30 kg/m2 or greater (“obese”). Among all 191 patients, the correlation coefficient was 0.04 (P > 0.2). The mean number of nodes harvested from 122 nonobese patients was 12.4 ± 6 and that for 69 obese patients 12.8 ± 6 (P > 0.2). Among 130 patients undergoing right colectomy and 35 patients undergoing sigmoid colectomy, the correlation coefficients were 0.02 (P > 0.2) and 0.16 (P > 0.2), respectively. There was not a statistically significant difference in lymph node harvest between obese and nonobese patients (14.1 ± 7 vs 13.8 ± 6, P > 0.2; and 11.8 ± 6 vs 8.6 ± 5, P > 0.2), respectively. Obesity did not compromise the number of lymph nodes harvested from patients undergoing colectomy for colon cancer.

Does body mass index affect lymph node retrieval in colon resection for cancer?

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 13571-13571 ◽  
Author(s):  
J. M. Pimiento ◽  
M. A. Cristancho ◽  
K. Aboulhosn ◽  
T. Fancher ◽  
J. A. Palesty ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Colon Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Body Mass ◽  
Colon Resection ◽  
Fatty Tissue ◽  
Specimen Length ◽  
Lymph Node Harvest ◽  
Lymph Node Retrieval

13571 Background: The management of colon cancer is a multidisciplinary effort that begins with adequate staging centered around the assessment of lymphatic spread. Multiple research groups have studied the number of lymph nodes retrieved and its relation with the outcome of patients with colon cancer, reporting better outcome in patients with a higher number of nodes retrieved. It has been well established that fatty tissue makes lymph node recovery difficult.Our objective was to evaluate if Body Mass Index (BMI) is associated with the number of lymph nodes retrieved, age, stage or location of the tumor. Methods: Retrospective chart review of patient who underwent colon resection for cancer between January 2001 to January 2005. Demographics, BMI and pathologic findings were recorded. Results: 395 patients had diagnosis of colon cancer, 140 underwent surgical procedures for these malignancies. Only 127 patients had complete records. The average age was 72 years. The average lymph node retrieval was 11.4. There was a significant relation between nodes harvested and specimen length (p 0.0028), age (p 0.0011), and stage IV cancer (p 0.002). There was no significant relationship between lymph node retrieval and BMI (p 0.1), location of the tumor (p 0.6) or stage I, II or III. Conclusion: We did not find any statistically significant correlation between BMI and lymph node retrieval, confirming reports that indicate the necessity of adequate lymph node harvest in patients with colon cancer for adequate staging and treatment. This may be because this study was done at a non-specialized center and because the operations were done by a number of different surgeons and the histopathology by numerous pathologists. The relation of improved lymph node harvest with greater specimen length supports other studies that point toward surgical and pathologic techniques as the most important factors in the appropriate staging of colon cancers. Hence, standardized surgical and histopathologic techniques need to be employed for harvesting adequate numbers of lymph nodes in resection specimens because number of nodes is critical to therapy, and an insufficient numbers of nodes may have a detrimental impact on colon cancer patient outcome. A prospective study should be performed in order to confirm the results of this study. No significant financial relationships to disclose.

Peri-operative morbidity and mortality in a modern series of patients treated with cytoreductive nephrectomy (CN) at five centers.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 268-268
Author(s):  
Ashanda Rosetta Patrice Esdaille ◽  
Jose A. Karam ◽  
Philippe E. Spiess ◽  
Jay D. Raman ◽  
Daniel D. Shapiro ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Systemic Therapy ◽  
Multivariable Analysis ◽  
Perioperative Outcomes ◽  
Cytoreductive Nephrectomy ◽  
Robotic Approach ◽  
Median Length ◽  
Perioperative Mortality ◽  
Major Complications ◽  
Ecog Ps

268 Background: For metastatic renal cell cancer (mRCC) patients considering cytoreductive nephrectomy (CN), perioperative morbidity is important to discuss but few contemporary multi-institutional data are available. The objective of this study is to describe factors associated with perioperative outcomes in a modern multi-institutional cohort of patients treated with cytoreductive nephrectomy. Methods: Data for perioperative complications was recorded for patients treated with CN at 5 centers from 2005-2019. Postoperative complications within 90 days were categorized using Clavien- Dindo system. Univariate and multivariable analysis was used to evaluate for associations with complications and 90-day mortality. Factors evaluated included receipt of pre-surgical systemic therapy, ECOG performance status (PS), Charlson comorbidity index (CCI), concurrent IVC thrombectomy, age, and surgical approach (open vs. laparoscopic/robotic). Results: Perioperative outcomes were evaluated in 937 consecutive patients treated with CN at 5 institutions from 2005-2019. Median age at surgery was 61 years (IQR 53-68) and median tumor diameter was 9.8cm (IQR 7-12).Venous thrombus was present in 406/937 (43.3%) patients overall including 65/406 (16%) patients for whom IVC thrombus extended above the hepatic veins. Open and laparoscopic/robotic approach was used in 715 (76.3%) and 290 (23.4%) patients. The median ECOG PS was 1 (IQR 0-1) and median CCI was 1 (IQR 0-2). Pre-surgical systemic therapy was given to 243 (25.9%) patients prior to CN. The median length of hospital stay was 5 days (IQR 4-7) and 429 (34.6%) received blood transfusion. Median length of stay was 3.0 (IQR 2-4) for laparoscopic/robotic approach and 6 days (IQR 4-8) for patients with IVC thrombectomy. Hospital readmission within 30 days was identified in 112 (9.0%) patients. A total of 93/937 (9.9%) patients had major (≥Clavien 3) complications identified within 90 days postoperatively. On multivariable analysis, IVC thrombectomy was associated with higher risk of major complications OR 1.95 (95% CI 1.2-3.1), p = 0.006. Pre-surgical systemic therapy, ECOG PS, CCI, age and surgical approach were not associated with major complications (p = 0.09-0.85). Perioperative mortality was 12/937 (1.3%) at 30 days and 51/937 (6.7%) at 90 days. After multivariable analysis, pre-surgical systemic therapy, ECOG PS, CCI, age, and IVC thrombectomy were not associated with perioperative mortality (p = 0.1-0.85). Conclusions: Cytoreductive nephrectomy is associated with major complications for 10% of patients and 1% mortality at 30 days. Pre-surgical systemic therapy was not associated with increased risk of complications or mortality.

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