Results of numerous retrospective studies have confirmed that the degree of cytoreduction and the size of the residual tumor after the primary surgery are the most important factors affecting overall life expectancy as well as the time to progression in patients with ovarian cancer (OC). The article presents the immediate results of the first 16 extensive cytoreductive surgeries in advanced OC performed at the Oncogynecology Department of the N.N. Petrov National Medical Research Center of Oncology.
Introduction: Concept of sentinel lymph node biopsy has been discussed during several last decades, because this idea seems perspective in terms of modern minimally invasive and organ-preserving era. However, this method has several limitations including complicated anatomy of gastric lymph nodes distribution and presence of skip-metastases. Materials and methods: 66 Patients with early gastric cancer, intermediate risk of lymph node metastases and technical possibility of ESD were included into our investigation. Patients were assigned to either ESD with sentinel lymph node biopsy (54 patients), or underwent distal gastrectomy or total gastrectomy with D1+/D2 lymphadenectomy (12 patients) by chance. Results: 56 (84,6%) Patients had at least one sentinel lymph node. 11 (16,7%) Patients with T1a-T1b had metastases in regional lymph nodes, 9 of them in sentinel lymph nodes (2 false-negative result). So, we calculated sensitivity of 84,6%. In one case, the metastasis was located outside the sentinel lymphatic basin, and in the other case, metastasis was detected in a patient with unlit lymph nodes. Conclusion: Today sentinel lymph node biopsy thechnique is considered as a well investigated and widly used method. The concept itself is promising for organ-preserving gastric cancer surgery.
The aim of this study was to define safety and oncological adequacy of radical laparoscopic interventions in gastric cancer (GC) in the conditions of a specialized oncology center. Materials and methods. The study included 193 (108 men and 85 women) with a histologically verified gastric adenocarcinoma of varying degrees of differentiation or cricoid-cell carcinoma with stage T1b-T4a cN0-N1 according to the UICC / TNM classification (7th edition). The study was prospective. The main group (laparoscopic interventions) included 81 patients: 54 underwent distal subtotal resections of the stomach (DSRS) and 27 underwent gastrectomies (GE); 101 patients (66 DSRSs and 35 GEs) contained the control group (open interventions). Separate group of 11 patients were with a conversion access. Results. The average duration of the laparoscopic DSRS was 209.6 ± 50.4 minutes, the open DSRS - 168.9 ± 44.1 minutes (p <0.05). The mean duration of laparoscopic GE was 241.7 ± 60.3 min, while the open GE was 185.1 ± 48.9 min (p <0.05). The average volume of intraoperative blood loss for laparoscopic DSRS was 100 ± 65.4 ml, with open DSRS - 217.4 ± 102.5 ml (p <0.05) and for laparoscopic and open GE it was 105.5 ± 45.2 ml and 247.1 ± 87.4 ml, respectively (p <0.05). The average number of removed lymph nodes in laparoscopic DSRS was 24,7 ± 5,1, with open DSRS - 25,4 ± 6,7 (p> 0,05), while in laparoscopic and open GE it was 25,1 ± 6, 4 and 26.8 ± 5.3, respectively (p> 0.05). In all cases of laparoscopic interventions R0 resection was performed. In the structure of postoperative complications the specific gravity of severe complications (IIIb - V degree according to the classification of Clavien-Dindo) in the subgroup of laparoscopic DSRS was 5.6%, in the subgroup of open DSRS - 6% (p> 0.05), and in subgroups of laparoscopic and open GE - 11.1% and 8.6%, respectively (p> 0.05). Postoperative lethality in the group of laparoscopic interventions was 1.2%, in the open surgery group - 2.9% (p> 0.05). The analysis of training curves in the performance of laparoscopic interventions demonstrated that the experience of 30 laparoscopic DSRSs and 15 laparoscopic GEs did not allow promoting an access to the plateau but it demonstrated the trend in reducing the duration of operations when accumulating experience. Conclusions. Radical laparoscopic operations for stomach cancer are safe and oncologically adequate. The absence of long-term results of treatment dictates the necessity of continuing the study.
The concept of biopsy of sentinel lymph node as the first lymph node in the pathway of lymphogenous tumor spread has been actively discussed over the past decades and has already taken its rightful place in breast and melanoma surgery. The goal of this method is to exclude vain lymphadenectomy in patients without solid tumor metastases in regional lymph nodes. In the era of minimally invasive and organ-saving operations interventions it seems obvious an idea to introduce a biopsy of sentinel lymph node in surgery of early gastric cancer. Meanwhile the complexity of lymphatic system of the stomach and the presence of so-called skip metastases are factors limiting the introduction of a biopsy of sentinel lymph node in stomach cancer. This article presents a systematic analysis of biopsy technology of signaling lymph node as well as its safety and oncological adequacy. Based on literature data it seems to us that the special value of biopsy of sentinel lymph nodes in the future will be in the selection of personalized surgical tactics for stomach cancer.
Background: Schwannoma is an extremely rare non-epithelial tumor of the pancreas. Less than 50 cases of pancreatic schwannoma have been described in the literature over the past thirty years and only few cases report has described its findings on Fine-Needle Aspiration (FNA). Preoperative diagnosis of pancreatic schwannoma can be particularly challenging. Pancreatic schwannomas may mimic other, more common pancreatic lesions, such as cystic neoplasms, solid neoplasms, neuroendocrine tumors. Cytomorphological verification of the diagnosis is difficult due to the similarity of Schwannomas with other non-epithelial tumors from spindle cells. Therefore, pancreatic schwannomas have a very high rate of misdiagnosis. Objective: demonstration preoperative diagnosis and treatment of a rare pancreatic tumor. Materials and methods: Here we present a case of preoperative cytomorphological diagnosis of pancreatic schwannoma in a 58-year-old man. During magnetic resonance imaging, computed tomography and endosonography (EUS), the patient was diagnosed the tumor in the head of the pancreas with a diameter of up to 7 cm. For morphological verification of the process, a fine needle aspiration puncture of the formation was performed under EUS control. Diagnosis of pancreatic schwannoma was established by cytomorphological examination of cell block material using immunocytochemical method. Conclusion: the analysis of the result of cytomorphological diagnosis of pancreatic schwannoma is presented.
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