Objective To summarize and analyze the different views on the lymph node metastasis and the extent of lymphadenectomy in gastric cancer.Methods The current domestic and foreign reports on lymph node metastasis and lymphadenectomy in gastric cancer were reviewed.Results Lymph node dissection of gastric cancer is based on clinical stage and the location of the tumor. Laparoscopic-assisted gastrectomy in treatment of gastric cancer is a safe， feasible， effective， and minimally invasive technique with good outcomes for patients. Sentinel lymph node（SLN） in the clinical assessment of early gastric cancer is feasible，besides with high accuracy and sensitivity. Lymphatic mapping is an effective， easy， and safe method to guide lymphadenectomy in gastric cancer. Evidence-based lymphadenectomy in gastric cancer provide a new perspective to the extent. Conclusions It is difficult to evaluate those methods exactly. Researchers over the world should learn from each other and explore further in order to develop guiding principles in the end.
ObjectiveTo summarize the current status and advances of sentinel lymph node biopsy (SLNB) technique in breast cancer. MethodsThe pertinent domestic and overseas literatures were reviewed and the localization, harvest, status assessment, indications, and complications of SLNB were analyzed. ResultsSLNB could accurately locate and pick out sentinel lymph node (SLN) in breast cancer. The development on imaging examination and pathological techniques promoted the assessment of SLN, and the indications of SLNB were expanding. The complication rate of SLNB was low and the technique could accurately predict axillary lymph node staging and direct selective axillary lymph node dissection. ConclusionsSLNB has been an important method of surgical therapy in breast cancer, but the operation process needs to be further standardized to decrease the false negative rate. Continuative attentions shall be paid to the problems such as the false positive and controversial indications.
ObjectiveTo study the significance of lateral lymph nodes sweeping in lower rectal cancer. MethodsRoutine pathological methods were used to detect the regularity of lateral lymph nodes metastasis and the survival rate of the patient. All the data was analysed by χ2 test. Results①Lateral lymph nodes metastasis was observed in 12.5% rectal cancer below the peritoneum,and it was the main lymph metastatic way. ②Low differented adenocarcinoma and mucous adenocarcinoma had more lateral lymph nodes metastasis than other types. Lateral lymph nodes metastasis was also related with invaded degree of invasion. ③The survival rate of the case with lateral lymph node metastasis was 42.2%.ConclusionLateral lymph nodes should be swept in advanced rectal cancer to prevent remains of lymph nodes remained and increase the survival rate.
Objective To summarize and analyze the different views on the extent of lymphadenectomy in gastric cancer, and ways or methods to dissolve the disagreements. Methods The reports and advances on lymphadenectomy in gastric carcinomas were collected and reviewed.Results Eastern and western scholars presented different view on lymph nodes dissection in gastric cancers because of the difference in nationalty,studying method and operating technique.Conclusion Although extended lymph node dissection for gastric cancers are supported by more and more reports, it is difficult to evaluate the role exactly. Searchers over the world should learn from each other and explore further in order to develop guiding principles in the end.
From Jan. 1980 to Dec. 1996, 138 cases of papillary adenocarcinoma of thyroid gland were surgically treated. To minimize the local recurrence and complication, resection of the involved lobe and the isthmus is an ideal surgical operation. Modified neck lymph node dissection should be performed, if the diameter of primary tumor is larger than 1.5 cm; whether the lymph node is palpable or not. Functional or classical radical neck lymph node excision should be taken, if the neck lymph node can be palpable.
Abstract： Objective To analyze the modes and rules of subcarinal lymph node metastasis in non-small cell lung cancer patients， and explore appropriate surgical dissection strategy of subcarinal lymph nodes for patients with non-small cell lung cancer. Methods The clinical data of 608 patients with non-small cell lung cancer who underwent lung resection and systematic lymph node dissection in Henan Cancer Hospital from September 2002 to October 2011 were analyzed retrospectively. There were 388 males and 220 females with an average age of 62.3 （45-78） years. There were 122 patients with left upper lobe tumor， 119 patients with left lower lobe tumor， 158 patients with right upper lobe tumor， 40 patients with right middle lobe tumor and 169 patients with right lower lobe tumor. Subcarinal lymph node metastasis was observed in 118 patients （19.4%）. There were 244 patients with squamous carcinoma， 285 patients with adenocarcinoma and 79 patients with other types of carcinoma. The relationship of subcarinal lymph node metastasis with tumor location， pathological types and clinicopathological characteristics were analyzed. Results There was statistical difference in subcarinal lymph node metastasis rate among different tumor locations （P=0.000）. Subcarinal lymph node metastasis rate was the highest ［45.8% （54/118）］ in patients with right lower lobe tumor. For patients with different pathological types， subcarinal lymph node metastasis rate was the highest ［55.9% （66/118）］ in patients with adenocarcinoma， and then squamous carcinoma （P=0.034）. Subcarinal lymph node metastasis rate increased with the increase in T staging， and patients with tumors located in the middle or lower lobe of the left or right lung had a significantly higher subcarinal lymph node metastasis rate than patients with upper lobe tumor. Conclusion Subcarinal lymph node metastasis rate are lower in patients with left or right upper lobe tumor， patients with squamous carcinoma whose clinical T staging is within cT 1 .
Barrett’s esophagus is considered an important risk factor for the pathogenesis of esophageal adenocarcinoma. Treatment strategies for diseases from high-grade dysplasia （HGD） to adenocarcinoma are different. The recurrence rates of endoscopic treatment and anti-reflux surgery are comparatively higher. Abnormal lesions of the esophagus can be completely resected by esophagectomy for the treatment of HGD to adenocarcinoma, and treatment outcomes are confirmed.But appropriate surgical strategies and lymph node dissection scopes should be chosen according to different cancer staging.Lymph node metastasis is a major factor in determining prognosis.
Abstract： Objective To evaluate the clinical significance of bilateral supraclavicular lymph node dissection after esophagectomy for patients with intrathoracic esophageal carcinoma. Methods A total of 197 patients with esophageal carcinoma but no obvious supraclavicular lymph node metastasis who underwent esophagectomy in Zhongshan Hospital of Xiamen University from March 1997 to September 2004 were included in this study. All the patients were divided into 2 groups， the control group and the study group. In the control group (non-supraclavicular lymphadenectomy group)， there were 96 patients including 62 males and 34 females with their age of 40-69 （55.2±3.1） years， who received 2-field lymphadenectomy (intrathoracic lymphatic drainage area and left paracardial lymph nodes) without supraclavicular lymph node dissection. In the study group (supraclavicular lymphadenectomy group)， there were 101 patients including 68 males and 33 females with their age of 41-68 （53.8±4.5） years， who received 3-field lymphadenectomy including intrathoracic lymphatic drainage area， left paracardial lymph nodes and bilateral supraclavicular lymph node dissection. Postoperative survival rate， lymph node metastasis rate， anastomotic site recurrence rate， and long-term supraclavicular lymph node metastasis rate were compared between the 2 groups. Results The overall 5-year survival rate of all the patients was 39.59% （78/197）. There was no statistical difference in 5-year survival rate between the 2 groups ［37.50％ （36/96） vs. 41.58％（42/101）， P＞0.05］. However， the 5-year survival rate of the patients with esophageal carcinoma in the upper third of the esophagus in the study group was significantly higher than that of the control group ［38.10％（8/21） vs. 29.17％ （7/24）， P＜0.05］. The intrathoracic lymph node metastasis rate （14.58% vs. 12.87%）， abdominal lymph node metastasis rate （6.25% vs. 7.92%）and anastomotic site recurrence rate （5.20% vs. 5.94%）of the control group and study group were not statistically different （P＞0.05）. However， long-term supraclavicular lymph node metastasis rate of the study group was significantly lower than that of the control group （2.97％ vs. 8.33％， P＜0.05） Conclusion Bilateral supraclavicular node dissection can significantly increase postoperative survival rate and decrease long-term supraclavicular lymph node metastasis rate of patients with esophageal carcinoma in the upper third of the esophagus.