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Retroperitoneal para-aortic ectopic pregnancies:A review of reported cases

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Gynecology and Obstetrics Clinical Medicine 2023年第4期3卷 220-228页

作者： Junxiang Ren Hongjing Han Department of Obstetrics and Gynecology Peking University People's HospitalXicheng DistrictBejing100044China

Objective:To gain insights into the diagnosis and treatment of retroperitoneal para-aortic ectopic pregnancies(RPEP).Methods:We conducted a review of the existing literature from the web of science,PubMed,and CNKI using the search terms"ectopic pregnancy"and'retroperitoneal."The present review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis(PRISMA)guidelines.Results:After applying the inclusion and exclusion criteria,we included a total of 54 relevant works,encompassing 55 cases.The studies have revealed that a history of artificial abortion,embryo transfer,salpingectomy,and uterine cavity operation,accounted for 65.5%(36/55)of the cases.Typical symptoms of RPEP include abdominal pain(43.6%,24/55)and vaginal bleeding(36.4%,20/55),with only 32.7%(18/55)of cases being asymptomatic.The most common sites of RPEP are the abdominal aorta and the inferior vena cava(74.5%,41/55).There were no statistically significant differences in the incidence of acute abdomen,diameter of the pregnancy sac,number of surgeries,and the time for postoperative hcG to normalize in different pregnant site.The most effective imaging examination for RPEP was found to be abdominal ultrasound(72.7%,40/55),and the most commonly used treatment method was laparoscopy surgery(55.3%,21/38).Conclusion:It is crucial to consider the possibility of RPEP when a pregnancy mass cannot be located during routine examinations.Expanding the scope of the scan may significantly expedite diagnosis and treatment.

关键词： Retroperitoneal pregnancy Ectopic pregnancy para-aortic Treatment

Systematic review of D2 lymphadenectomy versus D2 with para-aortic nodal dissection for advanced gastric cancer

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World Journal of Gastroenterology 2010年第9期16卷 1138-1149页

作者： Zhen Wang,Jun-Qiang Chen,Yun-Fei Cao,Department of Gastrointestinal Surgery,the First Affiliated Hospital of Guangxi Medical University,6 Shuangyong Road,Nanning 530021,Guangxi Zhuang Autonomous Region,China Department of Gastrointestinal Surgery The First Affiliated Hospital of Guangxi Medical University 6 Shuangyong Road Nanning 530021 Guangxi Zhuang Autonomous Region China.

AIM:To evaluate the feasibility and therapeutic effects of para-aortic nodal dissection (PAND) for advanced gastric cancer.METHODS:Randomized controlled trials (RCTs) and non-randomized studies comparing D2 + PAND with D2 lymphadenectomy were identified using a predefined search strategy.Five-year overall survival rate,post-operative mortality,and wound degree of surgery between the two operations were compared by using the methods provided by the Cochrane Handbook for Systematic Reviews of Interventions.RESULTS:Four RCTs (1120 patients) and 4 nonrandomized studies (901 patients) were identif ied.Metaanalysis showed that there was no signif icant difference between these two groups in 5-year overall survival rate [risk ratio (RR) 1.04 (95% CI:0.93-1.16) for RCTs and 0.96 (95% CI:0.83-1.10) for non-randomized studies] and post-operative mortality [RR 0.99 (95% CI:0.44-2.24) for RCTs and 2.06 (95% CI:0.69-6.15) for non-randomized studies].There was a significant difference between these two groups in wound degree of surgery,operation time was significantly longer [weighted mean difference (WMD) 195.32 min (95% CI:114.59-276.05) for RCTs and 126.07 min (95% CI:22.09-230.04) for non-randomized studies] and blood loss was signif icantly greater [WMD 301 mL (95% CI:151.55-450.45) for RCTs and 302.86 mL (95% CI:127.89-477.84) for non-randomized studies] in D2 + PAND.CONCLUSION:D2 + PAND can be performed as safely as standard D2 resection without increasing post-operative mortality but fail to benefit overall survival in patients with advanced gastric cancer.

关键词： Systematic review Meta-analysis Gastric cancer D2 lymphadenectomy para-aortic nodal dissection

Role of D2 gastrectomy in gastric cancer with clinical para-aortic lymph node metastasis

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World Journal of Gastroenterology 2019年第19期25卷 2338-2353页

作者： Xiao-Hao Zheng Wen Zhang Lin Yang Chun-Xia Du Ning Li Gu-Sheng Xing Yan-Tao Tian Yi-Bin Xie Department of Pancreatic and Gastric Surgery National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical College Department of Medical Oncology National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Department of Radiation Oncology National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Department of Diagnostic Radiology National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College

BACKGROUND Owing to the technical difficulty of pathological diagnosis, imaging is still the most commonly used method for clinical diagnosis of para-aortic lymph node metastasis(PALM) and evaluation of therapeutic effects in gastric cancer, which leads to inevitable false-positive findings in imaging. Patients with clinical PALM may have entirely different pathological stages(stage IV or not), which require completely different treatment strategies. There is no consensus on whether surgical intervention should be implemented for this group of patients. In particular, the value of D2 gastrectomy in a multidisciplinary treatment(MDT)approach for advanced gastric cancer with clinical PALM remains unknown.AIM To investigate the value of D2 gastrectomy in a MDT approach for gastric cancer patients with clinical PALM.METHODS In this real-world study, clinico-pathological data of all gastric cancer patients treated at the Cancer Hospital, Chinese Academy of Medical Sciences between 2011 and 2016 were reviewed to identify those with clinically enlarged PALM. All the clinico-pathological data were prospectively documented in the patient medical record. For all the gastric cancer patients with advanced stage disease,especially those with suspicious distant metastasis, the treatment methods were determined by a multidisciplinary team.RESULTS In total, 48 of 7077 primary gastric cancer patients were diagnosed as having clinical PALM without other distant metastases. All 48 patients received chemotherapy as the initial treatment. Complete or partial response was observed in 39.6%(19/48) of patients in overall and 52.1%(25/48) of patients in the primary tumor. Complete response of PALM was observed in 50.0%(24/48)of patients. After chemotherapy, 45.8%(22/48) of patients received D2 gastrectomy, and 12.5%(6/48) of patients received additional radiotherapy. The postoperative major complication rate and mortality were 27.3%(6/22) and 4.5%(1/22), respectively. The median overall survival and progression-free survival of all the p

关键词： Gastric cancer para-aortic lymph node Multidisciplinary Gastrectomy Conversion Neoadjuvant

Isolated para-aortic Nodal Recurrence in Endometrial Cancer

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Open Journal of Obstetrics and Gynecology 2018年第7期8卷 669-675页

作者： Motoki Matsuura Akimasa Takahashi Hidetaka Nomura Maki Matoda Sanshiro Okamoto Hiroyuki Kanao Kohei Omatsu Kazuyoshi Kato Kuniko Utsugi Nobuhiro Takeshima Department of Gynecologic Oncology Cancer Institute Hospital Tokyo Japan

Aim: While cytoreductive surgery should be considered for patients with regional recurrence of endometrial cancer, the management of isolated para-aortic lymph node recurrence remains controversial. We investigated the frequency of isolated recurrence in the para-aortic lymph nodes and the effectiveness of surgery for such recurrence. Methods: A retrospectively maintained endometrial cancer database at the Cancer Institute Hospital in Japan was reviewed to identify sites of metastasis and recurrence. Results: A total of 2322 patients with endometrial cancer underwent primary treatment with systemic lymphadenectomy between 1984 and 2015. Systematic pelvic and para-aortic lymph node dissection was performed in 889 patients (Group 1), while 1433 patients underwent dissection of only the pelvic lymph nodes (Group 2). Although 16 patients (1.1%) in Group 2 had isolated para-aortic recurrences, only 3 patients (0.3%) in Group 1 had documented recurrences in the para-aortic lymph nodes (p = 0.043). Although second recurrence occurred in 30.0% of patients who underwent surgical recurrence treatment, second recurrence occurred in 77.8% of patients who underwent non-surgical recurrence treatment (p = 0.037). In addition, the overall survival rate for patients who underwent surgical recurrence treatment (80.0%) was significantly higher than that for patients who underwent non-surgical recurrence treatment (33.3%) (p = 0.026). Conclusions: Patients who underwent dissection of only the pelvic lymph nodes had a higher frequency of isolated recurrence in the para-aortic lymph nodes. In addition, a relatively good prognosis could be achieved with surgical treatment for isolated recurrence in the para-aortic lymph nodes, which was better than that achieved using non-surgical methods.

关键词： Endometrial Cancer Recurrence Isolated para-aortic Nodal Recurrence

Effectiveness of intraoperative ultrasonography for para-aortic lymph nodes in preventing unnecessary lymphadenectomy in ovarian carcinoma

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Open Journal of Obstetrics and Gynecology 2013年第5期3卷 5-10页

作者： Eiji Ryo Tsunekazu Kita Toshiharu Yasugi Katsumi Mizutani Michiharu Seto Shigeki Takeshita Takuya Ayabe Department of Gynecology Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital Tokyo Japan Department of Obstetrics and Gynecology Teikyo University Tokyo Japan

Objective: To evaluate the usefulness of intraoperative ultrasonography (IU) for para-aortic nodes to identify women who do not require pelvic and paraaortic lymphadenectomy in ovarian carcinoma. Methods: Computed tomography (CT) was used for assessing both pelvic and para-aortic lymph nodes, and IU only for para-aortic nodes in 87 women with ovarian carcinoma. All women underwent surgery with routine systematic pelvic and para-aortic lymphadenectomy. We assumed that no lymphadenectomy had been performed when no enlarged node was detected by either CT or IU or when the woman was in T1 stage. Under these assumptions, the numbers of women who would have had missed metastases and who could have avoided lymphadenectomy were counted. These figures were recounted on the combination of T stage and IU. Results: A total of 22 women had pathological node metastases. The numbers of women with missed metastases on the basis of CT, IU, and T stage were 12, 2, 5, and these who could have avoided lymphadenectomy were 72, 39, and 49, respectively. There were more women avoiding lymphadenectomy by CT than IU and T stage;however, more women with missed node metastases. Both numbers were not significantly different between IU and T stage. On the combination of T stage and IU, 29 of 49 women in T1 stage could have avoided lymphadenectomy without missed metastases. Conclusions: IU for the para-aortic node is a useful method for identifying women who do not require lymphadenectomy for T1 stage ovarian carcinoma.

关键词： Intraoperative Ultrasonography Lymphadenectomy Lymph Node Lymph Node Metastases Ovarian Carcinoma para-aortic Ultrasound

Efficacy of para-aortic Lymphadenectomy in Ovarian Cancer: A Retrospective Study

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Journal of Cancer Therapy 2013年第5期4卷 28-32页

作者： Hiromi Ugaki Yosiko Komoto Reisa Kakubari Eriko Tanaka Hisashi Konishi Toshihiro Kitai Saori Nakajima Miho Muraji Takayuki Enomoto Masahiko Takemura Department of Obstetrics and Gynecology Niigata University Graduate School of Medical and Dental Science Niigata Japan. Department of Obstetrics and Gynecology Osaka General Medical Center Osaka Japan

Objective: The prognostic impact for ovarian cancer treatment of employing a systematic para-aortic and pelvic lymphadenectomy is still poorly defined. The purpose of this study was to evaluate the therapeutic efficacy of adding a para-aortic lymphadenectomy (PA) to the pelvic lymphadenectomy (PL), as compared with solely the pelvic lymphadenectomy. Materials and Methods: A retrospective study of patient outcomes was conducted of ovarian cancer patients who underwent optimal debulking surgery, concurrent with either PA + PL or PL alone, between 2000 and 2009 at our Osaka General Medical Center. Results: One hundred twenty-one patients with ovarian cancer underwent surgery. Forty-four patients (36%) underwent optimal debulking surgery (all residual disease was 1 cm) concurrent with lymphadenectomy. Seventeen patients underwent PA + PL (PA group), and 27 patients underwent PL alone (PL group). There were no significant differences in terms of overall survival (OS;hazard ratio [HR] = 0.49;95% CI, 0.13 to 1.82;p = 0.29) and progression-free survival (PFS;HR = 0.62;95% CI, 0.19 to 2.00;p = 0.40) between the PA group and the PL group. Both OS and PFS also failed to show significant differences, even when comparing them among 26 cases of FIGO stage I cases. Conclusions: Our data failed to show any prognostic improvement for ovarian cancer by adding para-aortic lymphadenectomy to the standard pelvic lymphadenectomy regimen.

关键词： Ovarian Cancer Pelvic Lymphadenectomy para-aortic Lymphadenectomy

Questionnaire survey regarding the current status of superextended lymph node dissection in Japan

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World Journal of Gastrointestinal Oncology 2016年第9期8卷 707-714页

作者： Shinji Morita Takeo Fukagawa Hisataka Fujiwara Hitoshi Katai Department of Surgical Oncology National Cancer Center HospitalChuo-kuTokyo

AIM To verify the current status of super-extended lymph node dissection for advanced gastric cancer according to a questionnaire survey.METHODS One-hundred and five institutions responded to the questionnaire.The survey included the following items: Number of experiences,whether performed prophylactically and/or therapeutically,whether preoperative chemotherapy was provided,number of preoperative chemotherapy rounds,and therapeutic options after chemotherapy.RESULTS Eighty-seven of the 105 institutions(83%) had performed D3 gastrectomy in the past or continued to perform D3 gastrectomy at present.However,D3 gastrectomy was rarely performed prophylactically in clinical practice.Seventy-eight institutions(74%) indicated that preoperative chemotherapy with curative intent was required for patients suspected of having para-aortic node(PAN) metastases.After chemotherapy,a D3 gastrectomy was scheduled for patients with a complete or partial response,stable disease,and progressive disease at 36(46%),28(36%),and 13(17%) of the institutions,respectively.CONCLUSION For patients with apparent PAN metastasis,a D3 gastrectomy is typically planned if a few courses of preoperative chemotherapy yield at least a stable disease condition.

关键词： Questionnaire survey Advanced gastric cancer Radical surgery para-aortic nodal dissection Preoperative chemotherapy