Case report: Robotic lymph node resection off the aortic bifurcation for presumed recurrence management of advanced ovarian cancer.
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SUBMITTER: Wilcox A
PROVIDER: S-EPMC10112163 | biostudies-literature | 2023 Apr
REPOSITORIES: biostudies-literature
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Case report: Robotic lymph node resection off the aortic bifurcation for presumed recurrence management of advanced ovarian cancer.
Wilcox Annemieke A Sartor Abigail A Menderes Gulden G
International journal of surgery case reports 20230323
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Project description:In recurrent ovarian cancer patients the addition of surgical cytoreduction is associated with prolonged overall survival compared to chemotherapy treatment alone when complete cytoreduction is achieved (Harter et al., 2021, Shi et al., 2021, Coleman et al., 2019). In the appropriate surgical candidates, a minimally invasive approach may be used to achieve complete cytoreduction of isolated lesions with proper exposure and surgical planning. This video demonstrates safe robotic entry into the lesser sac and resection of recurrent high-grade serous ovarian carcinoma near the pancreatic neck. The patient is a 78-year-old BRCA negative female with a history of a stage IIIC high-grade serous carcinoma. She previously underwent cytoreductive surgery and adjuvant chemotherapy in 2018 and presented 24 months later with a normal CA 125 and CT findings of an isolated lesion near the porta hepatis. An MRI was obtained preoperatively to further characterize the location of the lesion demonstrating a 2.2 × 1.6 cm hypoechoic mass adjacent to the pancreatic neck. Given the patient's prolonged disease-free interval, fitness for surgery and single site of disease, she met strict inclusion criteria for recent studies demonstrating clinical benefit with secondary cytoreduction (Harter et al., 2021, Shi et al., 2021). She was taken for a robotic secondary cytoreduction. At subsequent follow up 7 months later, our patient was still disease free and continues surveillance. In this video, we demonstrate the careful dissection of this isolated lesion from the omental bursa. We review important pre-procedural and anatomic considerations for robotic surgery in the lesser sac.
| S-EPMC9142552 | biostudies-literature
Project description:Objective: This study aimed at comprehensively investigating the survival impact of lymphadenectomy during primary surgery in ovarian cancer. Methods: Based on the surveillance, epidemiology, and end results registry (SEER) database, we included ovarian cancer patients with detailed information between 2010 and 2016. Cox regression was performed to select prognostic factors. We conducted propensity score-weighted survival analysis to balance baseline variables, and series of stratified analyses to control main confounding factors. Results: A total of 8,652 patients were ultimately identified. Among 4,360 patients with advanced disease, lymphadenectomy did not show significant survival benefit in general (median overall survival 44 months in non-lymphadenectomy vs. 49 months in lymphadenectomy group, P = 0.055). In subgroup analysis on patients received optimal debulking, lymphadenectomy did not significantly benefit the survival outcome (median overall survival 51, 47, 60, and 58 months in the non-lymphadenectomy, 1-9 lymph nodes, 10-19 lymph nodes, ≥20 lymph nodes groups, respectively, P = 0.287). Consistent results were observed in further stratification analyses. In optimal debulking subgroup, lymph node metastasis indicated worse survival. However, when limited the number of removed lymph nodes to more than 15, there was a marginal statistical difference in overall survival (P = 0.0498) while no significant difference presented in cause-specific survival (P = 0.129) between non-lymphadenectomy, pathological negative lymph node group and positive lymph node group. And the regions of lymph metastasis were also not significantly associate with survival (P = 0.123). Among 3,266 (75%) patients with apparent early-stage disease received lymphadenectomy, 7.75% of whom were reported isolated lymph nodes metastasis and have a poorer survival (P < 0.05). Conclusions: In primary debulking for patients with advanced ovarian cancer, lymphadenectomy was not associated with more favorable outcomes when compared to no lymphadenectomy. The value of lymphadenectomy lies more in staging for apparent early disease rather than therapeutic benefit.
| S-EPMC7096485 | biostudies-literature
Project description:IntroductionFor PDAC patients undergoing resection, it remains unclear whether metastases to the paraaortic lymph nodes (PALN+) have any prognostic significance and whether metastases should lead to the operation not being carried out. Our hypothesis is that PALN + status would be associated with short overall survival (OS) compared with PALN-, but longer OS compared with patients undergoing surgical exploration only (EXP).MethodsPatients with registered PALN removal from the nationwide Danish Pancreatic Cancer Database (DPCD) from May 1st 2011 to December 31st 2020 were assessed. A cohort of PDAC patients who only had explorative laparotomy due to non-resectable tumors were also included (EXP group). Survival analysis between groups were performed with cox-regression in a multivariate approach including relevant confounders.ResultsA total of 1758 patients were assessed, including 424 (24.1%) patients who only underwent explorative surgery leaving 1334 (75.8%) patients for further assessment. Of these 158 patients (11.8%) had selective PALN removal, of whom 19 patients (12.0%) had PALN+. Survival analyses indicated that explorative surgery was associated with significantly shorter OS compared with resection and PALN + status (Hazard Ratio 2.36, p < 0.001). No difference between PALN + and PALN- status could be demonstrated in resected patients after controlling for confounders.ConclusionPALN + status in patients undergoing resection offer improved survival compared with EXP. PALN + should not be seen as a contraindication for curative intended resection.
| S-EPMC10394933 | biostudies-literature
Project description:•Visualization of paraaortic sentinel compartments in endometrial cancer•Nerve sparing dissection of left paraaortic infrarenal lymph compartment•Educational video may be basis for standardization of paraaortic sentinel node dissection.
| S-EPMC5310174 | biostudies-literature
Project description:Robotic assisted laparoscopic retroperitoneal lymph node dissection (RPLND) has shorter hospitalizations and less morbidity compared to open RPLND. We describe and demonstrate with video the first report of outpatient robotic RPLND.
| S-EPMC9433607 | biostudies-literature
Project description:BackgroundSynchronous metastatic para-aortic lymph node (mPALN) dissectionin colorectal cancer has relatively good oncological outcomes, though many patients develop recurrence. Universal prognostic factor remain unclear and no definitive perioperative chemotherapy is available, making the treatment of mPALN controversial. In the present study, we aimed to establish a treatment strategy for synchronous mPALN.MethodsThis retrospective study involved 20 patients with pathological mPALN below the renal vein who underwent R0 resection. Long-term outcomes, recurrence type, and prognostic factors for survival were investigated.ResultsThe 5-year overall survival and recurrence-free survival rates were 39% and 25%, respectively. Seventeen patients (85%) developed recurrence, including 13 (76%) within 1 year after surgery, and ~ 70% of all recurrences were multiple recurrences. Four patients (20%) survived > 5 years. Pathological T stage (p= 0.011), time to recurrence (p = 0.007), and recurrence resection (p = 0.009) were identified as prognostic factors for long-term survival.ConclusionsR0 resection of synchronous mPALN in colorectal cancer resulted in acceptable oncological outcomes, though we found a high rate of early unresectable recurrence. If the recurrence occurs late or isolated, surgical resection should be considered for longer survival.
| S-EPMC7456015 | biostudies-literature
Project description:IntroductionD2 dissection has been regarded as the standard procedure for locally advanced gastric cancer (GC). Number of lymph nodes (LN) harvested is an important factor for accurate staging. The number of LN retrieved and the metastasis LN status are also important factors to determine the prognosis. This study aims to evaluate whether lymph node ratio (LNR) could be a prognostic indicator of GC patients following curative resection.Patients and methodsSingle center retrospective cohort study of GC patients underwent curative resection from January 1995 to December 2016 was conducted. The patients were categorized into 3 groups based on LNR (0.00-0.35, >0.35-0.75, and >0.75-1.00) and 2 groups based on number of LN retrieved (<15 and ≥ 15). Kaplan-Meier method was used to estimate recurrence-free survival. Cox-regression were used to determine the association between LNR/other factors and the disease recurrence.ResultsOne-hundred fifty-three patients were included in analysis. Univariate analysis showed that LNR >0.35, pathologic LN stages (pN) 2-3, higher number of LN metastasis, and TNM stage III were significantly recurrence risk factors. After adjusting for several covariates, LNR >0.35 still was significant predictor (adjusted HR [95%CI], 8.53 [1.97, 36.86]; p = 0.004) while number of LN retrieved or number of metastasis LN were not.ConclusionLNR could be a strong indicator for the recurrence of GC after curative resection while the number of LN retrieved or metastasis did not predict the recurrence. Future studies, such as prospective studies, are needed to confirm and identify the optimum LNR cut-off.
| S-EPMC7191314 | biostudies-literature
Project description:AimThe optimal surgical management strategy for para-aortic lymph node (PALN) metastasis has not attracted as much attention as surgery for liver or lung metastasis. The purpose of this retrospective study was to evaluate the oncologic outcomes after synchronous resection of PALN metastasis in left-sided colon and rectal cancer.MethodsBetween January 1986 and August 2016, 29 patients with pathologically positive PALN metastases who underwent curative resection at our hospital were retrospectively reviewed. We examined clinicopathological characteristics, long-term oncologic outcomes, and factors related to favorable prognosis in these patients.ResultsThe 3-year overall survival and recurrence-free survival (RFS) rates were 50.5% and 17.2%, respectively. In total, 6 (20.7%) patients experienced no recurrence in the 3 years after surgery, while postoperative complications were seen in 9 (31.0%) patients. The 3-year RFS rate was significantly better in the pM1a group than in the pM1b/pM1c group (26.3% and 0.0%, respectively, p = 0.032).ConclusionPALN dissection for patients without other organ metastases in left-sided colon or rectal cancer is a good indication as it is for liver and lung metastasis.
| S-EPMC7668564 | biostudies-literature
Project description:BackgroundIntraoperative para-aortic lymph node (PALN) sampling during surgical exploration in patients with suspected pancreatic head cancer remains controversial.ObjectiveThe aim of this study was to assess the value of routine PALN sampling and the consequences of different treatment strategies on overall patient survival.MethodsA retrospective, multicenter cohort study was performed in patients who underwent surgical exploration for suspected pancreatic head cancer. In cohort A, the treatment strategy was to avoid pancreatoduodenectomy and to perform a double bypass procedure when PALN metastases were found during exploration. In cohort B, routinely harvested PALNs were not examined intraoperatively and pancreatoduodenectomy was performed regardless. PALNs were examined with the final resection specimen. Clinicopathological data, survival data and complication data were compared between study groups.ResultsMedian overall survival for patients with PALN metastases who underwent a double bypass procedure was 7.0 months (95% confidence interval [CI] 5.5-8.5), versus 11 months (95% CI 8.8-13) in the pancreatoduodenectomy group (p = 0.049). Patients with PALN metastases who underwent pancreatoduodenectomy had significantly increased postoperative morbidity compared with patients who underwent a double bypass procedure (p < 0.001). In multivariable analysis, severe comorbidity (ASA grade 2 or higher) was an independent predictor for decreased survival in patients with PALN involvement (hazard ratio 3.607, 95% CI 1.678-7.751; p = 0.001).ConclusionIn patients with PALN metastases, pancreatoduodenectomy was associated with significant survival benefit compared with a double bypass procedure, but with increased risk of complications. It is important to weigh the advantages of resection versus bypass against factors such as comorbidities and clinical performance when positive intraoperative PALNs are found.
| S-EPMC7334266 | biostudies-literature
Project description: Not available
| S-EPMC4807177 | biostudies-literature