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Differences in rates of pelvic lymph node dissection in National Comprehensive Cancer Network favorable,unfavorable intermediate-and high-risk prostate cancer across United States SEER registries

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Current Urology 2022年第4期16卷 191-196页

作者： Rocco Simone Flammia Benedikt Hoeh Francesco Chierigo Lukas Hohenhorst Gabriele Sorce Zhen Tian Costantino Leonardo Markus Graefen Carlo Terrone Fred Saad Shahrokh F.Shariat Alberto Briganti Francesco Montorsi Felix K.H.Chun Michele Gallucci Pierre I.Karakiewicz Department of Maternal-Child and Urological Sciences Sapienza University RomePoliclinico Umberto I HospitalRome00161Italy Cancer Prognostics and Health Outcomes Unit Division of UrologyUniversity of Montréal Health CenterMontréalQuebecCanada Department of Urology University Hospital FrankfurtFrankfurt am MainGermany IRCCS Ospedale Policlinico San Martino GenovaItaly Martini-Klinik Prostate Cancer Center University Hospital Hamburg-Eppendorf HamburgGermany Department of Urology University Hospital Hamburg-Eppendorf HamburgGermany Department of Urology and Division of Experimental Oncology URIUrological Research InstituteIRCCS San Raffaele Scientific InstituteMilanItaly Department of Urology Comprehensive Cancer CenterMedical University of ViennaViennaAustria Department of Urology Weill Cornell Medical CollegeNew YorkNYUSA Department of Urology University of Texas SouthwesternDallasTXUSA Hourani Center for Applied Scientific Research Al-Ahliyya Amman UniversityAmmanJordan

Background:The National Comprehensive Cancer Network(NCCN)guidelines recommend pelvic lymph node dissection(PLND)in NCCN high-and intermediate-risk prostate cancer *** tested for PLND nonadherence(no-PLND)rates within the Surveillance Epidemiology and End Results(2010-2015).Materials and methods:We identified all radical prostatectomy patients who fulfilled the NCCN PLND guideline criteria(n=23,495).Nonadherence rates to PLND were tabulated and further stratified according to NCCN risk subgroups,race/ethnicity,geographic distribution,and year of ***:Overall,the no-PLND rate was 26%;it was 41%,25%,and 11%in the NCCN intermediate favorable,intermediate unfavorable,and high-risk prostate cancer patients,respectively(p<0.001).Overtime,the no-PLND rates declined in the overall cohort and within each NCCN risk *** exhibited the highest no-PLND rate(49%),whereas New Jersey exhibited the lowest(15%).Finally,no-PLND race/ethnicity differences were recorded only in the NCCN intermediate unfavorable subgroup,where Asians exhibited the lowest no-PLND rate(20%)versus African Americans(27%)versus Whites(26%)versus Hispanic-Latinos(25%).Conclusions:The lowest no-PLND rates were recorded in the NCCN high-risk patients followed by NCCN intermediate unfavorable and favorable risk in that *** findings suggest that unexpectedly elevated differences in no-PLND rates warrant further *** all the NCCN risk subgroups,the no-PLND rates decreased over time.

关键词： lymph node excision pelvic lymph node dissection Prostatectomy Prostatic neoplasms

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Early drainage removal in the management of lymphatic leakage after robotic pelvic lymph node dissection

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UroPrecision 2023年第4期1卷 185-190页

作者： Wei Wang Kai Zhang Hongbo Li Lihua Yuan Yan Hou Derek A.O'Reilly Gang Zhu Department of Urology Beijing United Family Hospital and ClinicsBeijingChina Department of Surgery Beijing United Family Hospital and ClinicsBeijingChina

Background:Radical prostatectomy(RP)and radical cystectomy(RC)with concurrent pelvic lymph node dissection(PLND)are considered as the curative surgical treatment options for localized prostate cancer(PC)or muscle-invasive bladder cancer(BC).Regarding lymphatic leakage management after PLND,there is no standard of care,with different therapeutic approaches having been reported with varying success ***:Seventy patients underwent pelvic lymphadenectomy during robotic RP and RC with postoperative pelvic drainage volume more than 50 mL/day before the removal of drainage tube,were retrospectively evaluated in this study between August 2015 and June *** the pelvic drainage volume on postoperative Day 2 was more than 50 mL/day,a drainage fluid creatinine was routinely tested to rule out urine *** removed the drainage if the patient had no significant abdominal free fluid collection,no abdominal distension or pain,no fever,and no abdominal *** 1-day observation of the vital signs and abdominal symptoms,the patient was discharged and followed-up in clinic for 2 weeks after ***:Forty-one cases underwent the early drainage removal even if the pelvic drainage volume was more than 50mL/*** these forty-one cases,twenty-five drainage tubes were removed when drainage volume was more than 100 mL/*** the forty-one cases with pelvic drainage volume greater than 50mL/day were successfully managed with the early drainage *** paracentesis or drainage placement was *** readmission occured during the follow-up ***:It is safe to manage the high-volume pelvic lymphatic leakage by early clamping of the drainage tube,ultrasonography assessment of no significant residual fluid in the abdominal and pelvic cavity,and then the early removal of the drainage tube.

关键词： bladder cancer lymphatic leakage pelvic drainage pelvic lymph node dissection prostate cancer robotic surgery

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Fluorescence imaging-guided pelvic lymph node localization and resection of bladder cancer after intracutaneous injection of indocyanine green into the lower limbs and perineum

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UroPrecision 2024年第3期2卷 109-117,I0012页

作者： Yangbing Wei Chao Liu Xiaoming Cao Bo Wu Liang Wei Hua Yang Chen Liu Haifeng Hao Qiang Jing Fan Liu Libing Sun Nianzeng Xing Xiaofeng Yang Department of Urology First Hospital of Shanxi Medical UniversityTaiyuanChina Shanxi Targeted Surgery Engineering Technology Research Center TaiyuanChina Department of Urology and State Key Laboratory of Molecular Oncology National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

Background:pelvic lymph node dissection(PLND)in radical cystectomy(RC)is of great significance,but the method and scope of PLND remain *** on the principle of indirect lymphadenography,we designed a method to localize the whole pelvic lymph nodes by intradermal injection of indocyanine green(ICG)through the lower limbs and perineum,and to evaluate the effectiveness of this method. Methods:In a single center,54 bladder cancer patients who underwent RC and PLND participated in a prospective clinical trial,which began on February 28,2022 and ended on December 30,*** solution was injected subcutaneously at the medial malleolus of both lower extremities and at both sides of the midline of the *** fluorescent laparoscopy was used to trace,locate,and remove the targeted areas under the image fusion *** consistency of lymph node resection was determined by histopathological *** impact of ICG guidance on the surgical time of PLND was compared with that of 11 bladder cancer patients who underwent RC and PLND without ICG injection,serving as the control group. Results:Perineal lower limb combined injection can provide comprehensive visualization of pelvic lymph *** technique reduces PLND surgical time and increases the accuracy of PLND. Conclusion:Intracutaneous injection of ICG into the lower limbs and perineum can specifically mark pelvic lymph *** fluores-cence imaging can accurately identify,locate,and resect lymph nodes in the pelvic region,reducing PLND surgical time and increasing the accuracy of PLND.

关键词： 4K fluoroscopic laparoscopy bladder cancer indocyanine green pelvic lymph node dissection radical cystectomy

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Feasibility and limitations of combined treatment for lateral pelvic lymph node metastases in rectal cancer

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World Journal of Clinical Oncology 2024年第5期15卷 591-593页

作者： Ying-Zi Zheng Fang-Fang Yan Lian-Xiang Luo The First Clinical College Guangdong Medical UniversityZhanjiang 524023Guangdong ProvinceChina The Marine Biomedical Research Institute Guangdong Medical UniversityZhanjiang 524000Guangdong ProvinceChina

Colorectal cancer ranks among the most commonly diagnosed cancers globally,and is associated with a high rate of pelvic recurrence after *** efforts to mitigate recurrence,pelvic lymph node dissection(PLND)is commonly advocated as an adjunct to radical *** chemoradiotherapy(NACRT)is a therapeutic approach employed in managing locally advanced rectal cancer,and has been found to increase the survival *** et al have proposed a combination of NACRT with selective PLND for addressing lateral pelvic lymph node metastases in rectal cancer patients,with the aim of reducing recurrence and improving survival ***,certain studies have indicated that the addition of PLND to NACRT and total mesorectal excision did not yield a significant reduction in local recurrence rates or improvement in ***,meticulous patient selection and perioperative chemotherapy may prove indispensable in ensuring the efficacy of PLND.

关键词： Rectal cancer Lateral pelvic lymph nodes metastases pelvic lymph node dissection Neoadjuvant chemoradiotherapy Total mesorectal excision

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Current perspectives on the management of lateral pelvic lymph nodes in rectal cancer

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World Journal of Clinical Oncology 2023年第12期14卷 584-592页

作者： Jonathan Yu Jin Chua James Chi Yong Ngu Nan Zun Teo Department of General Surgery Changi General HospitalSingapore 529889Singapore

Significant controversies exist with regards to the optimal management of lateral pelvic lymph nodes metastases(mLLN)in patients with low rectal *** differing views held by Japanese and Western clinicians on the management of mLLN have been well ***,the adequacy of pelvic lymph node dissection(PLND)or neoadjuvant chemoradiation(NACRT)alone in addition to total mesorectal excision(TME)have recently come into question,due to the relatively high incidence of lateral local recurrences following PLND and TME,or NACRT and TME ***,a more selective approach to PLND has been suggested,involving a combination of neoadjuvant therapy,followed by PLND only to patients in whom the oncological benefit is likely to outweigh the risk of potential adverse events.A number of studies have attempted to retrospectively identify certain nodal characteristics on preoperative imaging,such as nodal size,appearance,and size reduction following neoadjuvant ***,no consensus has been reached regarding the optimal criteria for a selective approach to PLND,partly due to the heterogeneity and retrospective nature of most of these *** review aims to provide an overview of recent evidence with regards to the diagnostic challenges,considerations for,and outcomes of the current management strategies for mLLN in rectal cancer patients.

关键词： pelvic lymph node dissection Lateral pelvic lymph nodes Diagnostic criteria Short axis diameter Radiotherapy Rectal cancer

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Management of lateral pelvic lymph nodes in rectal cancer:Is it time to reach an Agreement?

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World Journal of Clinical Oncology 2024年第4期15卷 472-477页

作者： Sigfredo E Romero-Zoghbi Fernando López-Campos Felipe Couñago Department of Radiation Oncology GenesisCareTalavera de la Reina 45600ToledoSpain Department of Radiation Oncology Hospital Universitario Ramón Y CajalMadrid 28034Spain Department of Radiation Oncology GenesisCare-Hospital Universitario Vithas Madrid La MilagrosaMadrid 28010Spain

In this editorial,we proceed to comment on the article by Chua et al,addressing the management of metastatic lateral pelvic lymph nodes(mLLN)in stage II/III rectal cancer patients below the peritoneal *** treatment of this nodal area sparks significant controversy due to the strategic differences followed by Eastern and Western physicians,albeit with a higher degree of convergence in recent *** dissection of lateral pelvic lymph nodes without neoadjuvant therapy is a standard practice in Eastern *** contrast,in the West,preference leans towards opting for neoadjuvant therapy with chemoradiotherapy or radiotherapy,that would cover the treatment of this area without the need to add the dissection of these nodes to the total mesorectal *** the presence of high-risk nodal characteristics for mLLN related to radiological imaging and lack of response to neoadjuvant therapy,the risk of lateral local recurrence increases,suggesting the appropriate selection of strategies to reduce the risk of recurrence in each patient *** the heterogeneous and retrospective nature of studies addressing this area,an international consensus is necessary to approach this clinical scenario uniformly.

关键词： Rectal cancer Lateral pelvic lymph node metastases pelvic lymph node dissection Total neoadjuvant therapy Selective management of the lateral pelvic nodes Prophylactic management of the lateral pelvic nodes Chemoradiotherapy Total mesorectal excision

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