The intra-operative application of collagen-fibrin sealants (CFS) has emerged as a promising intervention to reduce post-operative morbidity associated with inguino-femoral lymph node dissection (IFLND).
The purpose of this systematic review was to ascertain the efficacy and safety of CFS to reduce lymphatic morbidity after IFLND.
We systematically searched MEDLINE, SCOPUS, ClinicalTrials.gov, and Cochrane Database to identify all registered articles pertaining to the use of CFS during IFLND spanning the period Jan 1975 to April 2020. A direct-comparison meta-analysis was performed. Odds ratios (OR), standartised mean difference (SMD) and 95%| confidence intervals were calculated using the random-effect model.
A total of six randomised control trials (RCTs) and four observational studies were included in this study. The studies were characterised by significant clinical heterogeneity. The meta-analysis of RCTs showed that the application of CFS did neither decrease the length of drainage [SDM -0.55 (95% CI -1.34 to 0.23), p = 0.17] nor the amount of drained output [SMD 0.46 (95% CI -0.29 to 1.20), p = 0.23]. No significant different was found concerning the incidence of lymphocele(s) formation [OR 0.96 (95% CI 0.56-1.65), p = 0.88] or other wound complications. The safety profile of CFS was favourable.
Our findings suggest that the use of CFS was not associated with difference in the incidence of lymphatic morbidity related to IFLND. In light of the limited data available and the high inter-study heterogeneity, this evidence should be interpreted with caution. More high quality RCTs are warranted to draw firmer conclusions.
Our findings suggest that the use of CFS was not associated with difference in the incidence of lymphatic morbidity related to IFLND. In light of the limited data available and the high inter-study heterogeneity, this evidence should be interpreted with caution. read more are warranted to draw firmer conclusions.
The optimal extent of lymph node dissection in patients receiving non-curative endoscopic submucosal dissection (ESD) and diagnosed with a positive vertical margin is unclear. This study attempted to identify optimal candidates for D2 lymph node dissection among these patients.
This study included patients who underwent gastrectomy for primary gastric cancer following non-curative ESD with a positive vertical margin between January 2002 and December 2018. We classified the patients according to the positive vertical margin pattern into an obvious exposure group and a non-obvious exposure group. We developed a score model for predicting lymph node metastasis (LNM) using factors selected by multivariate analyses and beta regression coefficients, and the incidence of LNM was evaluated.
This study included 110 patients. LNM was detected in 17 patients (15%). We developed a predictive scoring system as follows tumor size >30mm (0, No; 1, Yes)+undifferentiated type tumor in the invasive front (0, No; 2, Yes)+depth of submucosal invasion>1500μm (0, No; 1, Yes)+obvious tumor exposure at the vertical margin (0, No; 1, Yes). In patients with 5 points, the incidence rates of all and group 2 LNM were as high as 60% and 40%, respectively. Conversely, in patients with fewer than 5 points, the incidence rates of all and group 2 LNM were just 11% and 5%, respectively.
In patients with 5 points according to our score model for predicting LNM, gastrectomy with D2 lymph node dissection is recommended.
In patients with 5 points according to our score model for predicting LNM, gastrectomy with D2 lymph node dissection is recommended.
Microcystic, elongated, and fragmented (MELF) pattern of myoinvasion has been related with increased risk of lympho-vascular space invasion (LVSI) and lymph node metastasis. We analysed a cohort of endometrioid endometrial carcinomas (EECs) to examine the relationships between the MELF pattern of invasion and the clinico-pathological and immunohistochemical features of EEC.
129EECs were evaluated for the presence of MELF pattern and immunohistochemically tested for Mismatch repair (MMR) proteins, p16, p53 and beta-catenin. We observed 28 MELF+EECs and 101 MELF- EECs. LVSI was observed in 20 MELF+cases and in MELF- tumors. Lymph-node metastases were observed in 7 MELF+cases (2 macrometastases, 3 micrometastases and 2 ITCs). None of the MELF- cases showed micrometastases or ITCs, 18 cases had macrometastatic lymph-nodes. Statistical analysis showed that MELF+tumors carry an increased risk of developing nodal metastasis independent of tumor dimension and LVSI. Loss of MMR proteins expression was observed in micrometastases or ITCs, 18 cases had macrometastatic lymph-nodes. Statistical analysis showed that MELF + tumors carry an increased risk of developing nodal metastasis independent of tumor dimension and LVSI. Loss of MMR proteins expression was observed in 11 MELF + cases and 45 MELF- cases, respectively. Our data showed a higher frequency of immunohistochemical MLH1-PMS2 loss in MELF- pattern of invasion (32.67% of MELF- cases vs 21.43% of MELF + cases) but a higher prevalence of MSH2-MSH6 loss in MELF + pattern (7.14% in MELF + population vs 3.96% of MELF- population) CONCLUSIONS The morphological recognition of MELF pattern is more reliable than immunohistochemical and molecular signatures of EEC in predicting the risk of nodal involvement. The observed higher prevalence of MSH2-MSH6 loss in MELF + group and MLH1-PMS2 loss in MELF- group may suggest a different molecular signature.
We report an unusual case compression of the palmar cutaneous branch of the median nerve(PCBNN).
A 52-year-old woman presenting with previous rupture of the palmaris longus tendon. #link# During surgery, we found that the end of the tendon had formed nodules. After removing the nodules, the PCBMN was released, and half a year later, the abnormal feelings had disappeared.
We aim to remind surgeons of this type of compression and to highlight the importance of maintaining vigilance in order to avoid nerve injury.
PCBMN needs to be paid more attention and damaged tendons should be repaired.
PCBMN needs to be paid more attention and damaged tendons should be repaired.read more
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