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.
To investigate the relationship between clinicopathological features and lymph node metastasis in the primary gastric cancer and affer the basis for deciding appropriate extent of lymph node dissection, a total of 192 patients who underwent curative gastrectomy and lymph node dissection for gastric cancer were analyzed retrospectively. Result: The total rate of lymph node metastasis was 60.4%, with 28.9% of the resected lymph nodes involved. The lymph node metastasis of C, M, A region and the whole stomach were 64.6%, 57.7%, 59.1% and 90.9% respectively. The rates of the lymph node metastasis increased successively in carcinoma of early, middle and late stages (Ｐ＜0.05), the rate of the infiltrative tumor (Borr Ⅲ，Ⅳ) being 76.5% which was significantly higher than that of the circumscribed tumor (Borr Ⅰ，Ⅱ) (43.2%)。 Relating with the tumor size ＜4cm in diameter showed lesser rate, while 4-8 cm and ＞8cm in diameter showed increasingly higher metastaticrate (Ｐ＜0.01). As a result, we should decide the appropriate extent of lymph node dissection during the operation on the basis of clinicopathological stages, type of Borrmann’s, site and maximum diameter of gastric cancer along with the state of lymph node metastasis in carcinoma of different region of the stomach.
Objective To evaluate the safety，efficacy，short- and long-term clinical outcomes of complete video-assisted thoracoscopic surgery （VATS） lobectomy for non-small cell lung cancer （NSCLC）. Methods Clinical data of231 consecutive patients with NSCLC who underwent complete VATS lobectomy in the First Affiliated Hospital of NanjingMedical University between June 2006 and March 2011 were retrospective analyzed. There were 132 male and 99 femalepatients with their age of 15-81 （59.51±11.90） years. Preoperative cancer staging wasⅠa in 149 patients，Ⅰb in 50 patients，Ⅱa in 14 patients，Ⅱb in 13 patients and Ⅲa in 5 patients. There were 152 patients with adenocarcinoma，41 patients with squamous carcinoma，23 patients with bronchioalveolar carcinoma，5 patients with adenosquamous carcinoma，4 patients with large cell carcinoma，and 6 patients with other carcinoma. Follow-up data were statistically analyzed，and short-and long-term survival rates were calculated. Results No perioperative mortality was observed. Operation time was 60-370（199.14±51.04） minutes，and intraoperative blood loss was 10-2 300 （168.19±176.39） ml. Thirty-seven patients had postoperative complications including air leak，pulmonary infection，atelectasis，arrhythmia，subcutaneous emphysema andothers，who were all cured after conservative treatment. Mean number of dissected lymph nodes was 11.14±5.49，and meannumber of explored nodal stations was 3.66±1.52. There were 51 patients （22.08%） whose postoperative cancer staging wasmore advanced than preoperative cancer staging. Postoperative hospital stay was 3-36 （10.79±5.13） days. Primary causesof prolonged postoperative hospitalization included pulmonary air leak，pulmonary infection，preoperative concomitant chronic pulmonary diseases （COPD，asthma），and moderate to severe pulmonary dysfunction. A total of 228 patients werefollowed up for a mean duration of 40.83 months （22-82 months），and 3 patients were lost during follow-up. Overall 5-yearsurvival rates were 85.78%，52.54% and 32.70% for stageⅠ，stageⅡand stageⅢ-Ⅳpatients respectively. Five-year cancerfreesurvival rates were 80.00%，45.37% and 20.99% for stageⅠ，stageⅡand stageⅢ-Ⅳpatients respectively. ConclusionThe advantages of VATS lobectomy include smaller surgical incision，less injury and postoperative pain，quicker postoperative recovery and shorter hospital stay. Long-term survival rate is comparable to previous international and Chinese studies. VATS lobectomy can anatomically achieve complete tumor resection and systematic lymph node dissection. VATS lobectomy will become a standard surgical procedure for NSCLC patients.
ObjectiveTo summarize the new ideas and new instruments in thyroid surgery. MethodsRelated literatures were reviewed and analyzed. ResultsTotal thyroidectomy had become the preferred option for differentiated thyroid cancer and multiple nodule goiter. The key change of surgery was from recurrent laryngeal nerve-protection to parathyroid-protection. Harmonic scalpel, bipolar coagulation forceps and Ligasure were used to thyroid surgery, which could shorten operation time and reduce operative bleeding. ConclusionThe ideas and techniques of thyroid surgery have changed, total thyroidectomy and parathyroid protection are being paid more and more attentions, and new instruments are used more extensively in thyroid surgery.
ObjectiveTo study the regularity of cervical lymph node metastasis in papillary thyroid carcinoma and a reasonable surgical method. MethodsThe clinical data of 221 cases of papillary thyroid carcinoma treated in this hospital between September 2004 and September 2009 were analyzed retrospectively. ResultsThere were 32 cases treated with total thyroidectomy, 189 patients with subtotal thyroidectomy. Two hundred and two patients with unilateral thyroid carcinoma and 19 patients with bilateral thyroid carcinoma were diagnosed by pathology. The diameter of tumor was 0.2-8.0 cm with an average of 3.5 cm. The amicula invasion was found in 50 cases and mulifocality in 33 cases. The numbers of lymph node dissection were 10-24 with an average of 14.3 in unilateral. The total lymph node metastasis rate was 37.56% (83/221), the lymph node metastasis rate was 33.94% (75/221) in the Ⅵ region, and which was 18.10% (40/221) in the Ⅱ+Ⅲ+Ⅳ region. The rate of cervical lymph node metastasis markedly increased in the patients with the primary tumor diameter gt;1.0 cm, amicula invasion, multifocality, or age gt;45 years in the Ⅵ region and ipsilateral of Ⅱ+Ⅲ+Ⅳ region (Plt;0.05). ConclusionsIn patients with thyroid papillary carcinoma, the most common lymph node metastasis happened in the Ⅵ region, next in the Ⅱ+Ⅲ+Ⅳ region. Lymph nodes of the Ⅵ region should routinely be dissected in the first surgery, the lymph nodes of the Ⅱ+Ⅲ+Ⅳ region should be dissected when the tumor diameter gt;1.0 cm, amicula invasion, multifocality or ultrasonic, CT, and other imaging examinations demonstrated cervical lymph node metastasis.
ObjectiveTo investigate the risk factors for neck lymph node metastasis (LNM) in papillary thyroid microcarcinoma, analyze the diagnostic value of high resolution ultrasonography in lateral neck LNM, and evaluate the safety of lymph node dissection. MethodsThe clinical data of 284 patients with papillary thyroid microcarcinoma from Janaury 2004 to June 2010 in this hospital were analyzed retrospectively. ResultsNeck LNMs were found in 83 of 284 patients (29.2%), only central LNMs in 63 of 284 patients (22.2%), skip LNMs (only lateral LNMs) in 6 of 284 patients (2.1%), and both central and lateral LNMs in 14 of 284 patients (4.9%). Age lt;45 years, multifocality, tumor diameter ≥5 mm, and extrathyroidal invasion were the risk factors for LNM (Plt;0.05), and no risk factor for skip LNM was found. Patients underwent central and lateral lymph node dissection had longer postoperative hospital stay than those without dissection or with central lymph node dissection only (Plt;0.05). Both parathyroid gland and recurrent laryngeal nerve injuries were temporary postoperatively. There were no differences in injury rate among three methods (Pgt;0.05). The sensitivity, specificity, false negative rate, and false positive rate of high resolution ultrasonography for only lateral neck LNM were 95.0%, 75.0%, 5.0%, and 25.0%, repectively. The positive predictive value and negative predictive value were 90.5% and 85.7%, respectively. ConclusionsTotal thyroidectomy should be performed in patients with risk factors for LNM, and simultaneous central lymph node dissection is safe. High resolution ultrasonography is of great value in diagnosing skip LNM, and functional lymph node dissection also should be applied in patients who are highly suspected to have skip LNM.
ObjectiveTo explore the feasibility and the practical value of conserving upper limb lymph nodes in axillary lymph node dissection (ALND) for early breast cancer. MethodsFrom August 2007 to January 2010, 124 patients with early breast cancer were studied and divided into two phases: phase one, from August 2007 to July 2008; phase two, from August 2008 to January 2010. Five milliliter of methylene blue was injected subcutaneously in ipsilateral forearm in all the patients before operation to locate the upper limb lymph nodes. Routine ALND was performed in 22 patients of phase one. The level Ⅱ lymph nodes and the upper limb lymph nodes were separated from the axillary lymph nodes, respectively. The lymph nodes of level Ⅱ were investigated by combining touch cytology with frozen section during operation. The lymph nodes of level Ⅰ, Ⅱ, Ⅲ, and the upper limb lymph nodes were investigated postoperatively by routine pathological examination to evaluate the feasibility of conserving the upper limb lymph nodes. One hundred and two patients in phase two were divided randomly by lottery into control group (30 cases), and conserving group (72 cases) in which upper limb lymph nodes were selectively conserved. The surgical procedure for control group was same as the phase one blue stained upper limb lymph nodes, in the conserving group were conserved selectively when the lymph nodes metastasis of level Ⅱ were not detected by combining touch cytology with frozen section during operation. The data were collected and analysed on pathological results of all patients and arm circumference was compared between control group and conserving group. Results Total 119 of 124 patients (96.0%) were found with blue stained upper limb lymph nodes. The concordance rate was 99.2% (123/124) between the intraoperative combining pathological method and the postoperative routine pathological examination. No upper limb lymph node metastasis was found in the phase one and the control group of phase two with level Ⅱ group negative. The incidence of arm lymphedema in the control group and the conserving group with level Ⅰ and Ⅱ lymph nodes dissection was 18.2% （4/22） and 20% （1/51）, respectively on 6 months after operation. The difference was statistically significant （χ 2=6,34， Plt;0.05）. ConclusionsMethylene blue being injected subcutaneously in ipsilateral upper limb can be used to show validly lymph nodes of upper limb in the axillary region. ALND with selectively conserving upper limb lymph nodes when level Ⅱ lymph nodes negative in metastasis, can prevent postoperative arm lymphedema.
ObjectiveTo investigate the clinical value of elective central compartment lymph node dissection for cN0 papillary thyroid carcinoma. MethodThe clinical data of 326 patients with cN0 papillary thyroid carcinoma from January 2007 to December 2011 in this hospital were analyzed retrospectively. ResultsThe lymph node metastasis incidence was 35.89%(117/326) in 326 patients with cN0 papillary thyroid carcinoma, which in the patients with age < 45 years, tumor diameter > 1 cm, and thyroidal tumor infiltrated envelope were significantly higher than those in the pati-ents with age≥45 years, tumor diameter≤1 cm, and thyroidal tumor not-infiltrated envelope (age:46.56% versus 28.72%, P=0.001;tumor diameter:44.44% versus 26.45%, P=0.001;infiltrated envelope:50.00% versus 33.09%, P=0.020).Multivariate analysis showed that age < 45 years and tumor diameter > 1 cm were independent risk factors for central compartment lymph node metastasis of cN0 papillary thyroid carcinoma.There were 6 cases of temporary recu-rrent laryngeal nerve injury, 18 cases of temporary hypoparathyroidism, 4 cases of temporary superior laryngeal nerve injury, and 1 case of acute caryngeal edema.There were no complications such as permanent laryngeal nerve injury and permanent hypoparathyroidism.Three cases had lateral cervical lymph node metastases during a follow-up of 7-67 months (mean 31.2 months). ConclusionsIt is necessary and safe to perform elective central compartment lymph node dissec-tion for cN0 papillary thyroid carcinoma.The elective central compartment lymph node dissection should be considered in patients with cN0 papillary thyroid carcinoma, especially in patients with age of < 45 years and tumor diameter > 1 cm.
ObjectiveTo summarize the current situation and progress of sentinel lymph node biopsy (SLNB) in breast cancer. MethodsDomestic and foreign documents related SLNB in breast cancer in recent years were collected to summaize some problems about the definition, indications, biopsy techniques, improvement methods of the detection rate, the pathological examinations of sentinel lymph node (SLN), the types of metastasis, clinical applications of SLNB technology in breast cancer, and so on. ResultsThe indications of SLNB were expanding. The development of the tracer, imaging examination, and pathological detection technology contributed to the status assessment of SLN in breast cancer. The operation method of SLNB in breast cancer had no uniform standards yet. There were many arguments on whether SLNB can guide axillary lymph node dissection, and the detection rate and the false negative rate of it varied widely. ConclusionsSLNB technology has became an important method in the surgical therapy of breast cancer, but the operation still needs to be further standardized. The clinical application of SLNB also needs a lot of prospective multicenter randomized experiments for further demonstration.
ObjectiveTo investigate the value of central lymph node dissection in patients with cN0 papillary thyroid carcinoma. MethodThe clinical data of 128 patients with cN0 papillary thyroid carcinoma who had been performed central lymph node dissection during their hospitalization from December 2010 to July 2012 in Chinese PLA General Hospital were analyzed retrospectively. ResultsThe central neck lymph node metastasis rate was 35.94%(46/128) in 128 patients with cN0 papillary thyroid carcinoma, which in the patients with aged less than 45 years, with the tumor diameter larger than 1 cm, and with capsule or extrathyroidal invasion were significantly higher than those in the patients with aged larger than 45 years, with the tumor diameter less than 1 cm, and without capsule or extrathyroidal invasion (P < 0.05). After the operation, there were 22(17.19%) patients with temporary hypoparathyroidism as well as 3(2.34%) patients with temporary recurrent laryngeal nerve injury. However, no permanent recurrent laryngeal nerve injury and permanent hypoparathyroidism occurred. During the 14-32 months follow-up with an average 23.4 months, 2 cases of lateral neck lymph node metastases were observed. ConclusionAs an essential, effective, and safe operation to the patients with cN0 papillary thyroid carcinoma, central lymph node dissection should be performed by experienced hands.