Prevention of lymphocele development in gynecologic cancers by the electrothermal bipolar vessel sealing device

Naotake Tsuda,Kimio Ushijima,Kouichiro Kawano,Shuji Takemoto,Shin Nishio,Gounosuke Sonoda,Toshiharu Kamura 대한부인종양학회 2014 Journal of Gynecologic Oncology Vol.25 No.3

Objective: A number of new techniques have been developed to prevent lymphocele formation after pelvic lymphadenectomy in gynecologic cancers. We assessed whether the electrothermal bipolar vessel sealing device (EBVSD) could decrease the incidence of postoperative lymphocele secondary to pelvic lymphadenectomy. Methods: A total of 321 patients with gynecologic cancer underwent pelvic lymphadenectomy from 2005 to 2011. Pelvic lymphadenectomy without EBVSD was performed in 134 patients, and pelvic lymphadenectomy with EBVSD was performed in 187 patients. We retrospectively compared the incidence of lymphocele and symptoms between both groups. Results: Four to 8 weeks after operation, 108 cases of lymphocele (34%) were detected by computed tomography scan examination. The incidence of lymphocele after pelvic lymphadenectomy was 56% (75/134) in the tie ligation group, and 18% (33/187) in the EBVSD group. We found a statistically significant difference in the incidence of lymphocele between both groups (p<0.01). To detect the independent risk factor for lymphocele development, we performed multivariate analysis with logistic regression for three variables (device, number of dissected lymph nodes, and operation time). Among these variables, we found a significant difference (p<0.001) for only one device. Conclusion: Use of the EBVSD during gynecological cancer operation is useful for preventing the development of lymphocele secondary to pelvic lymphadenectomy.

Role of lymphadenectomy for ovarian cancer

Mikio Mikami 대한부인종양학회 2014 Journal of Gynecologic Oncology Vol.25 No.4

Japan Society of Gynecologic Oncology (JSGO) recently revised its Ovarian Cancer Treatment Guidelines and the 4th edition will be released next year. This Guidelines state that lymphadenectomy is essential to allow accurate assessment of the clinical stage in early ovarian cancer, but there is no randomized controlled trial that shows any therapeutic efficacy of lymphadenectomy. In patients with advanced stage tumors, lymphadenectomy should be considered if optimal debulking has been performed. I fully agree with this recommendation of the JSGO and I would like to discuss the role of lymphadenectomy in the management of ovarian cancer.

Analysis of para-aortic lymphadenectomy up to the level of the renal vessels in apparent early-stage ovarian cancer

장석준,Robert E. Bristow,유희석 대한부인종양학회 2013 Journal of Gynecologic Oncology Vol.24 No.1

Objective: The aim of this study was to evaluate the impact of para-aortic lymphadenectomy up to the renal vessels on the accurate staging in ovarian cancer patients presumed preoperatively to be confined to the ovary. Methods: We retrospectively analyzed data on 124 patients with primary epithelial ovarian cancer who were preoperatively thought to have tumor confined to the ovary and underwent primary staging surgery. The distribution of lymph node metastasis and various risk factors for nodal involvement were investigated. Results: Surgical staging yielded: 87 (70.2%) patients had International Federation of Gynecology and Obstetrics (FIGO)stage I disease and 37 (29.8%) patients had stage II-III disease: 4 IIA, 6 IIB, 9 IIC, 1 IIIA, and 17 IIIC. Eighty-six patients had pelvic lymphadenectomy only and 69 had pelvic and para-aortic lymphadenectomy. Lymph node metastases were found in 17 (24.6%)of 69 patients; 5 (7.2%) patients had lymph node metastasis in the pelvic lymph nodes only, 8 (11.6%) in the para-aortic lymph nodes only, and 4 (5.8%) in both pelvic and para-aortic lymph nodes. Six (8.7%) patients had lymph node metastasis in the paraaortic lymph node above the level of the inferior mesenteric artery. On multivariate analysis, grade 3 tumor (p=0.01) and positive cytology (p=0.03) were independent predictors for lymph node metastasis. Conclusion: A substantial number of patients with apparently early ovarian cancer had upstaged disease. Of patients who underwent lymphadenectomy, some patients had lymph node metastasis above the level of the inferior mesenteric artery. Paraaortic lymphadenectomy up to the renal vessels may detect occult metastasis and be of help in tailoring appropriate adjuvant treatment as well as giving useful information about the prognosis.

Sentinel lymph Node mapping versus systematic pelvic lymphadenectomy on the prognosis for patients with intermediate-high-risk Endometrial Cancer confined to the uterus before surgery: trial protocol for a non-inferiority randomized controlled trial (SNE

Jun Guan,Yu Xue,Rong-yu Zang,Ji-hong Liu,Jian-qing Zhu,Ying Zheng,Bo Wang,Hua-ying Wang,Xiao-jun Chen 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.4

Background: Sentinel lymph node (SLN) mapping has been recommended as an alternative staging approach to lymphadenectomy for apparent uterine-confined endometrial cancer (EC). However, the prognostic value of SLN mapping alone instead of systematic lymphadenectomy on EC patients remains unclear. Methods: A multi-center, open label, non-inferiority randomized controlled trial has been designed to identify if SLN mapping alone is not inferior to pelvic lymphadenectomy on prognosis of patients with intermediate-high-risk EC clinically confined to uterus. Eligible patients will be 1:1 randomly assigned to accept SLN mapping or pelvic lymphadenectomy. The primary endpoint is the 2-year progression-free survival (PFS). The second points are the 5-year PFS, 5-year overall survival, surgery-related adverse events and life quality. A total of 780 patients will be enrolled from 6 hospitals in China within 3-year period and followed up for 5 years. Trial Registration: ClinicalTrials.gov Identifier: NCT04276532

Obesity does not affect the number of retrieved lymph nodes and the rate of intraoperative complications in gynecologic cancers

Mehmet Coskun,Alp Usubutun,Tulay Ozlu,Kubra Boynukalin,Kunter Yuce 대한부인종양학회 2010 Journal of Gynecologic Oncology Vol.21 No.1

Objective: Lymphadenectomy, in general, is a safe and well-tolerated procedure in gynecologic oncology. However,some technical difficulties may be experienced in obese women which may result in inadequate lymphadenectomy and increased complications. The purpose of this study is to retrospectively evaluate the effect of obesity on lymph node counts retrieved and complication rates observed during lymphadenectomy in gynecologic cancers. Methods: Patients with ovarian, endometrial or cervical cancers treated with initial surgery including bilateral pelvic and paraaortic lymph node dissection were grouped as non-obese and obese. These two groups were compared in terms of the number of retrieved lymph nodes and the rate of intraoperative complications directly related to lymph node dissection. Results: One hundred twenty-three patients were eligible with a mean age of 55.1 years and mean body mass index of 29.2 kg/m2. Fifty-nine patients were obese while 64 were non-obese. Lymph node counts obtained in different stations and in total were similar among non-obese and obese patients. Rates of lymphadenectomy-related intraoperative complications including vascular, neural, intestinal, and bladder injury were also similar in non-obese and obese patients. Conclusion: The obesity does not affect the lymph node counts and intraoperative complication rates adversely in women with gynecologic cancers. Therefore, adequate lymph node dissection should not be omitted based solely upon obesity in gynecologic oncology patients.

Single-port laparoscopic transperitoneal infrarenal para-aortic lymphadenectomy as part of staging operation for early ovarian cancer and high grade endometrial cancer

이윤순 대한부인종양학회 2016 Journal of Gynecologic Oncology Vol.27 No.3

Objective: The aim of this paper was to demonstrate the techiniqes of single-portlaparoscopic transperitoneal infrarenal paraaortic lymphadenectomy as part of surgicalstaging procedure in case of early ovarian cancer and high grade endometrial cancer. Methods: After left upper traction of rectosigmoid, a peritoneal incision was made caudadto inferior mesenteric artery. Rectosigmoid was mobilized, and then the avascular space ofthe lateral rectal portion was found by using upward traction of rectosigmoid mesentery. Inframesenteric nodes were removed without injury to the ureter and the left common iliacnodes were easily removed due to the upward traction of the rectosigmoid. The superiorhypogastric plexus was found overlying the aorta and sacral promontory, and presacral nodeswere removed at subaortic area. Peritoneal traction suture to right abdomen was needed forright para-aortic lymphadenectomy. After right lower para-aortic node dissection, operatorwas situated between the patient’s legs. After upper traction of the small bowel, left upperpara-aortic nodes were removed. To prevent chylous ascites, we used hemolock or Ligasureapplication (ValleyLab Inc.) to upper part of infrarenal and aortocaval nodes. Results: Single-port laparoscopic transperitoneal infrarenal para-aortic lymphadenectomywas performed without serious perioperative complications. Conclusion: Even though the technique of single-port surgery is still a difficult operation,the quality of single-port laparoscopic transperitoneal infrarenal para-aortic node dissectionis excellent, especially mean number of para-aortic nodes. In cases of staging procedures forovary and endometrial cancer, single-port transperitoneal para-aortic lymphadenectomy isacceptable as an oncologic procedure.

A case of massive serous ascites following radical hysterectomy with bilateral pelvic lymphadnectomy for cervical adenocarcinoma stage IB2

홍대기,김보섭,이윤순,박일수,조영래 대한부인종양학회 2008 Journal of Gynecologic Oncology Vol.19 No.1

Ascites following radical hysterectomy with retroperitoneal lymphadenectomy for invasive cervical cancer has been reported previously. Most of these reports described chylous ascites. The chylous ascitic fluid is milky; further, chylous ascites leads to nutritional problems. Authors present the case of a patient who developed serous ascites following radical hysterectomy with bilateral pelvic lymphadenectomy. The amount of ascites was approximately 18,000 ml over 52 days. The patient had no nutritional problems or complications. Although the etiology could not be determined, Authors surmise that the ascites may have been due to massive drainage from injured lymphatic channels below the cisterna chyli. Authors could not found any literatures which described massive serous ascites following surgery in gynecologic malignancy and reports this case with review of literatures. Ascites following radical hysterectomy with retroperitoneal lymphadenectomy for invasive cervical cancer has been reported previously. Most of these reports described chylous ascites. The chylous ascitic fluid is milky; further, chylous ascites leads to nutritional problems. Authors present the case of a patient who developed serous ascites following radical hysterectomy with bilateral pelvic lymphadenectomy. The amount of ascites was approximately 18,000 ml over 52 days. The patient had no nutritional problems or complications. Although the etiology could not be determined, Authors surmise that the ascites may have been due to massive drainage from injured lymphatic channels below the cisterna chyli. Authors could not found any literatures which described massive serous ascites following surgery in gynecologic malignancy and reports this case with review of literatures.

소아 고환난황낭종에서 후복막 임파절절제술에 의한 치헝 2rTl

문두건,천준,김제종,고성건 大韓泌尿器科學會 1997 Korean Journal of Urology Vol.38 No.10

The Feasibility of Robot-Assisted Laparoscopic Radical Cystectomy with Pelvic Lymphadenectomy: from the Viewpoint of Extended Pelvic Lymphadenectomy

강승철,강성구,최훈,고영휘,이정구,김제종,천준,강석호 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.9

Purpose: We evaluated the feasibility of robot-assisted laparoscopic radical cystectomy (RARC) with pelvic lymph node dissection (PLND), especially extended PLND (ePLND), during our initial experience with this technique. Materials and Methods: From August 2007 to March 2009, prospective data were obtained from the 21 consecutive patients who underwent RARC with PLND at Korea University Hospital. Data included baseline characteristics, perioperative variables, pathological outcomes, and complications. Evidence of the lymph node yield curve was examined by using linear regression to compare the number of lymph nodes obtained. Results: Among 21 patients who underwent RARC, 13 had ileal conduit urinary diversion and 8 had orthotopic neobladder. Standard PLND (sPLND) was performed in the first 15 patients, and ePLND was performed in the more recent 6 patients. The mean total operative time was 515.5±145.1 minutes, and the mean estimated blood loss was 346.8±205.9 ml. The mean time for PLND was 106.7±25.2 minutes in patients with ePLND and 72.1±14.1 minutes in patients with sPLND (p=0.001). All patients had negative surgical margins. The mean number of retrieved nodes was 23.5±12.8 (range, 8-50) in all patients: 38.6±10.8 (range, 29-50) in ePLND and 15.7±12.2 (range, 8-21) in sPLND. Conclusions: Perioperative data and oncologic features showed that RARC with PLND is feasible. Robot-assisted laparoscopic surgery is a safe and effective procedure with acceptable morbidity and good oncologic results from the viewpoint of PLND, especially ePLND. Purpose: We evaluated the feasibility of robot-assisted laparoscopic radical cystectomy (RARC) with pelvic lymph node dissection (PLND), especially extended PLND (ePLND), during our initial experience with this technique. Materials and Methods: From August 2007 to March 2009, prospective data were obtained from the 21 consecutive patients who underwent RARC with PLND at Korea University Hospital. Data included baseline characteristics, perioperative variables, pathological outcomes, and complications. Evidence of the lymph node yield curve was examined by using linear regression to compare the number of lymph nodes obtained. Results: Among 21 patients who underwent RARC, 13 had ileal conduit urinary diversion and 8 had orthotopic neobladder. Standard PLND (sPLND) was performed in the first 15 patients, and ePLND was performed in the more recent 6 patients. The mean total operative time was 515.5±145.1 minutes, and the mean estimated blood loss was 346.8±205.9 ml. The mean time for PLND was 106.7±25.2 minutes in patients with ePLND and 72.1±14.1 minutes in patients with sPLND (p=0.001). All patients had negative surgical margins. The mean number of retrieved nodes was 23.5±12.8 (range, 8-50) in all patients: 38.6±10.8 (range, 29-50) in ePLND and 15.7±12.2 (range, 8-21) in sPLND. Conclusions: Perioperative data and oncologic features showed that RARC with PLND is feasible. Robot-assisted laparoscopic surgery is a safe and effective procedure with acceptable morbidity and good oncologic results from the viewpoint of PLND, especially ePLND.

Intraoperative Nerve Monitoring during Minimally Invasive Esophagectomy and 3-Field Lymphadenectomy: Safety, Efficacy, and Feasibility

Srinivas Kodaganur Gopinath,Sabita Jiwnani,Parthiban Valiyuthan,Swapnil Parab,Devayani Niyogi,Virendrakumar Tiwari,C. S. Pramesh 대한심장혈관흉부외과학회 2023 Journal of Chest Surgery (J Chest Surg) Vol.56 No.5

Background: The objective of this study was to demonstrate the safety, efficacy, and feasibility of intraoperative monitoring of the recurrent laryngeal nerves during thoracoscopic and robotic 3-field esophagectomy. Methods: This retrospective analysis details our initial experience using intraoperative nerve monitoring (IONM) during minimally invasive 3-field esophagectomy. Data were obtained from a prospectively maintained database and electronic medical records. The study included all patients who underwent minimally invasive (video-assisted thoracic surgery/robotic) transthoracic esophagectomy with neck anastomosis. The patients were divided into those who underwent IONM during the study period and a historical cohort who underwent 3-field esophagectomy without IONM at the same institution. Appropriate statistical tests were used to compare the 2 groups. Results: Twenty-four patients underwent nerve monitoring during minimally invasive 3-field esophagectomy. Of these, 15 patients underwent thoraco-laparoscopic operation, while 9 received a robot-assisted procedure. In the immediate postoperative period, 8 of 24 patients (33.3%) experienced vocal cord paralysis. Relative to a historical cohort from the same institution, who were treated with surgery without nerve monitoring in the preceding 5 years, a 26% reduction was observed in the nerve paralysis rate (p=0.08). On follow-up, 6 of the 8 patients with vocal cord paralysis reported a return to normal vocal function. Additionally, patients who underwent IONM exhibited a higher nodal yield and a decreased frequency of tracheostomy and bronchoscopy. Conclusion: The use of IONM during minimally invasive 3-field esophagectomy is safe and feasible. This technique has the potential to decrease the incidence of recurrent nerve palsy and increase nodal yield.