Survival benefit with extended lymphadenectomy for advanced renal malignancy: A population-based analysis

Objective:We used population-based data to examine the possible benefit of extended lymphadenectomy for patients with renal malignancy in the setting of more advanced disease.Methods:The Surveillance,Epidemiology,and End Results(SEER)database was utilized to identify non-metastatic,T3-T4 renal cancer patients from 2004-2015 treated with removal of≥1 lymph node at the time of nephrectomy.Non-parametric bivariate statistics were used to assess associations between covariates of interest and extended lymphadenectomy(≥10 lymph nodes removed).Cancer-specific survival(CSS)and overall survival(OS)benefit was evaluated using Kaplane-Meier analysis.Results:Of the 4397 patients identified,816(18.6%)underwent extended lymphadenectomy.For patients with T3a disease,5-year CSS and OS benefit with extended lymphadenectomy did not reach statistical significance(CSS:hazard ratio[HR]0.98,95%confidence interval[CI]0.77-1.24;OS:HR 0.96,95%CI 0.77-1.20).Conversely,for those with T3b-T3c disease,extended lymphadenectomy led to statistically significant improvements in both 5-year CSS and OS compared to non-extended lymphadenectomy(CSS:HR 0.78,95%CI 0.61-0.99;OS:HR 0.72,95%CI 0.58-0.90).Finally,for those with T4 disease,use of extended lymphadenectomy had OS benefit after 5 years(OS:HR 0.51,HR 0.29-0.90,p = 0.02).Conclusion:Based on population-level data,extended lymphadenectomy was associated with improved survival in select patients with advanced renal malignancy treated with surgical nephrectomy.Understanding the basis of these real-world findings in the face of conflicting randomized trial results will be key,moving forward.

Clinical value of extended lymphadenectomy in radical surgery for pancreatic head carcinoma at different T stages

BACKGROUND As the lymph-node metastasis rate and sites vary among pancreatic head carcinomas(PHCs)of different T stages,selective extended lymphadenectomy(ELD)performance may improve the prognosis of patients with PHC.AIM To investigate the effect of ELD on the long-term prognosis of patients with PHC of different T stages.METHODS We analyzed data from 216 patients with PHC who underwent surgery at our hospital between January 2011 and December 2021.The patients were divided into extended and standard lymphadenectomy(SLD)groups according to extent of lymphadenectomy and into T1,T2,and T3 groups according to the 8 th edition of the American Joint Committee on Cancer’s staging system.Perioperative data and prognoses were compared among groups.Risk factors associated with prognoses were identified through univariate and multivariate analyses.RESULTS The 1-,2-and 3-year overall survival(OS)rates in the extended and SLD groups were 69.0%,39.5%,and 26.8%and 55.1%,32.6%,and 22.1%,respectively(P=0.073).The 1-,2-and 3-year disease-free survival rates in the extended and SLD groups of patients with stage-T3 PHC were 50.3%,25.1%,and 15.1%and 22.1%,1.7%,and 0%,respectively(P=0.025);the corresponding OS rates were 65.3%,38.1%,and 21.8%and 36.1%,7.5%,and 0%,respectively(P=0.073).Multivariate analysis indicated that portal vein invasion and lymphadenectomy extent were risk factors for prognosis in patients with stage-T3 PHC.CONCLUSION ELD may improve the prognosis of patients with stage-T3 PHC and may be of benefit if performed selectively.

Evaluation of rational extent lymphadenectomy for local advanced gastric cancer

Based upon studies from randomized clinical trials, the extended （D2） lymph node dissection is now recommended as a standard procedure for local advanced gastric cancer worldwide. However, the rational extent lymphadenectomy for local advanced gastric cancer has remained a topic of debate in the past decades. Due to the limitation of low metastatic rate in para-aortic nodes （PAN） in JCOG9501, the clinical benefit of D2＋ para-aortic nodal dissection （PAND） for patients with stage T4 and/or stage N3 disease, which is very common in China and other countries except Japan and Korea, cannot be determined. Furthermore, the role of splenectomy for complete resection of No.10 and No.l I nodes has been controversial, and however, the final results from the randomized trial ofJCOG0110 have yet to be completed. Gastric cancer with the No.14 and No.13 lymph node metastasis is defined as MI stage in the current version of the Japanese classification. We propose that D2~No.14v and ＋No.13 lymphadenectomy may be an option in a potentially curative gastrectomy for tumors with apparent metastasis to the No.6 nodes or infiltrate to duodenum. The examined lymph node and extranodal metastasis are significantly associated with the survival of gastric cancer patients.

Radical resection of pancreatic cancer

BACKGROUND: Pancreatic adenocarcinoma (PCa) is a disease with dismal prognosis, and the only possibility of cure, albeit small, is based on the combination of complete resection with negative histopathological margins (R0 resection) with adjuvant treatment. Therefore, a lot of effort has been made during the last decade to assess the role of extensive surgery in both local recurrence and survival of patients with PCa. DATA SOURCES: Medline search and manual cross- referencing were utilized to identify published evidence- based data for PCa surgery between 1973 and 2006, with emphasis to feasibility, efficacy, long-term survival, disease free survival, recurrence rates, pain relief and quality of life. RESULTS: Extended surgery is safe and feasible in high volume surgical centers with comparable short-term results. Organ preserving surgery is a main goal because of quality of life reasons and is performed whenever possible from the tumor extent. Concerning long-term survival major vein resection does not adversely affect outcome. To date, there are no changes in long-term survival attributed to the extended lymph node dissection. However, there is a benefit in locoregional control with fewer local recurrences and extended lymphadenectomy allows better staging for the disease. CONCLUSIONS: Extended PCa surgery is safe and feasible despite the inconclusive results in patient’s survival benefit. In the future, appropriately powered randomized trials of standard vs. extended resections may show improved outcomes for PCa patients.

The optional extent of lymph node dissection for pancreatic head cancer

Objective The extent of lymph node dissection for pancreatic head cancer(PHC)is uncertain and controversial;therefore,this study evaluated whether PHC patients can benefit from different extents of lymph node dissection.Methods A total of 106 PHC patients underwent standard regional lymphadenectomy(SRLN;n=56,52.8%)and extended regional lymphadenectomy(ERLN;n=50,47.2%)between September 2015 and September 2019.None of the study participants had distant metastases.The median survival time and complications were compared between the two groups.Results The median survival time in the SRLN and ERLN groups was 27.01 months and 21.17 months,respectively(P=0.30).The postoperative major morbidity and mortality rates were 37.50%and 1.79%in the SRLN group,and 46.00%and 2.00%in the ERLN group,respectively.Moreover,the tumor differentiation,tumor diameter,lymph node involvement,perineural invasion,vascular invasion,and margin status all correlated with survival(P<0.05).Conclusion For PHC patients,ERLN cannot provide a significant survival benefit over SRLN.Moreover,ERLN increased morbidity and mortality,although without statistical significance.This indicates that ERLN should not be considered in PHC patients.

Chylorrhea complicating D2＋a gastrectomy： review of the literature and clarification of terminology apropos one case

Lymphatic complications leading to retention,accumulation or drainage of peritoneal fluid are frequently encountered following extended or superextended lymphadenectomy for gastric cancer.1 The vast majority of these drainages usually subsides spontaneously, but in some instances they can persist for long period of time causing significant morbidity.However, the classification,