• Journal of Gastric Cancer
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• v.20 no.1
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• pp.19-28
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• 2020

Gastrectomy with lymph node dissection remains the gold standard for curative treatment of gastric cancer. Dissection of splenic hilar lymph nodes has been included as a part of D2 lymph node dissection for proximal gastric cancer. Previously, pancreatico-splenectomy has been performed for dissecting splenic hilar lymph nodes, followed by pancreas-preserving splenectomy and spleen-preserving lymphadenectomy. However, the necessity of routine splenectomy or splenic hilar lymph node dissection has been under debate due to the increased morbidity caused by splenectomy and the poor prognostic feature of splenic hilar lymph node metastasis. In contrast, the relatively high incidence of splenic hilar lymph node metastasis, survival advantage, and therapeutic value of splenic hilar lymph node dissection in some patient subgroups, as well as the effective use of novel technologies, still supports the necessity and applicability of splenic hilar lymph node dissection. In this review, we aimed to evaluate the need for splenic hilar lymph node dissection and suggest the subgroup of patients with favorable outcomes.

• Journal of Chest Surgery
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• v.54 no.4
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• pp.258-262
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• 2021

Mediastinal lymph node dissection is an important part of lung cancer surgery that provides accurate nodal staging and may improve survival outcomes. The minimally invasive approach, such as video-assisted thoracic surgery (VATS) lobectomy for patients with non-small cell lung cancer, has become a standard operation worldwide. VATS mediastinal lymph node dissection should be thorough and accurate to ensure the completeness of lung cancer surgery. Herein, the author describes techniques for VATS mediastinal lymph node dissection.

• Journal of Chest Surgery
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• v.54 no.5
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• pp.342-347
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• 2021

Thoracic surgeons need to be aware of several important points regarding intraoperative lymph node dissection during surgery for non-small cell lung cancer with ground-glass opacities. The first point relates to the need for lymph node dissection during sublobar resection. Since even patients undergoing sublobar resection may benefit from lymph node dissection, it should be selectively performed according to adequate indications, which require further study. Second, there seems to be no difference in postoperative morbidity between systematic sampling and systematic dissection, but the survival benefit from systematic dissection remains unclear. The results of randomized controlled trials on this topic are conflicting, and their evidence is jeopardized by a high risk of bias in terms of the study design. Therefore, further randomized controlled trials with a sound design should investigate this issue. Third, more favorable survival outcomes tend to be positively associated with the number of examined lymph nodes. Minimum requirements for the number of examined lymph nodes in non-small cell lung cancer should be defined in the future. Finally, lobe-specific lymph node dissection does not have a negative prognostic impact. It should not be routinely performed, but it can be recommended in selected patients with smaller, less invasive tumors. Results from an ongoing randomized controlled trial on this topic should be awaited.

• Journal of Chest Surgery
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• v.28 no.10
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• pp.954-962
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• 1995

Extended lymph node dissection, which includes dissection of the cervical and superior mediastinal nodes[three-field dissection , has been performed to improve the long-term survival since 1982 in Japan. Recently, the 5-year survival rate after three-field dissection has been reported to be better than 40%. During the period, from April to June, 1995, 4 patients among 7 operable esophageal cancer patients underwent subtotal esophagectomy with systematic dissection of regional lymph nodes including superior mediastinal and cervical lymph nodes at St. Mary`s Hospital. The esophagogastric anastomoses were made in the neck and the ascending routes of gastric tube were posterior mediastinal route. The cancer stage of them were stage IIA & IIB and it was possible to operate on a curability II & III basis. The numbers of resected lymph nodes with the three field dissection were 40-55. Postoperative complications were transient recurrent laryngeal nerve paralysis and atelectasis in 2 patients respectively but there was no anastomotic leak nor stenosis.

• Journal of Chest Surgery
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• v.54 no.4
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• pp.239-245
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• 2021

Video-assisted thoracoscopic surgery (VATS) has been established as the surgical approach of choice for lobectomy in patients with early-stage non-small cell lung cancer (NSCLC). Patients with clinical stage I NSCLC with no lymph node metastasis are considered candidates for VATS lobectomy. To rule out the presence of metastasis to lymph nodes or distant organs, patients should undergo meticulous clinical staging. Assessing patients' functional status is required to ensure that there are no medical contraindications, such as impaired pulmonary function or cardiac comorbidities. Although various combinations of the number, size, and location of ports are available, finding the best method of port placement for each surgeon is fundamental to maximize the efficiency of the surgical procedure. When conducting VATS lobectomy, it is always necessary to comply with the following oncological principles: (1) the vessels and bronchus of the target lobe should be individually divided, (2) systematic lymph node dissection is mandatory, and (3) touching the lymph node itself and rupturing the capsule of the lymph node should be minimized. Most surgeons conduct the procedure in the following sequence: (1) dissection along the hilar structure, (2) fissure division, (3) perivascular and peribronchial dissection, (4) individual division of the vessels and bronchus, (5) specimen retrieval, and (6) mediastinal lymph node dissection. Surgeons should obtain experience in enhancing the exposure of the dissection target and facilitating dissection. This review article provides the basic principles of the surgical techniques and practical maneuvers for performing VATS lobectomy easily, safely, and efficiently.

• Journal of Gastric Cancer
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• v.20 no.1
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• pp.1-18
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• 2020

Splenic hilar lymph node dissection has been the standard treatment for advanced proximal gastric cancer. Splenectomy is typically performed as part of this procedure. However, splenectomy has some disadvantages, such as increased risk of postoperative complications, especially pancreatic fistula. Moreover, patients who underwent splenectomy are vulnerable to potentially fatal infection caused by encapsulated bacteria. Furthermore, several studies have shown an association of splenectomy with cancer development and increased risk of thromboembolic events. Therefore, splenectomy should be avoided if it does not confer a distinct oncological advantage. Most studies that compared patients who underwent splenectomy and those who did not failed to demonstrate the efficacy of splenectomy. Based on the results of a randomized controlled trial conducted in Japan, prophylactic dissection with splenectomy is no longer recommended in patients with gastric cancer with no invasion of the greater curvature. However, patients with greater curvature invasion or those with remnant gastric cancer still need to undergo splenectomy to facilitate splenic hilar node dissection. Spleen-preserving splenic hilar node dissection is a new procedure that may help delink splenic hilar node dissection and splenectomy. In this review, we examine the evidence pertaining to the efficacy and disadvantages of splenectomy. We discuss the possibility of spleen-preserving surgery for prophylactic splenic hilar node dissection to overcome the disadvantages of splenectomy.

• The Journal of the Korean dental association
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• v.48 no.8
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• pp.594-606
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• 2010

Lymph node status is the single most important prognostic factor in oral cancer because lymph node involvement decreases overall survival by 50%. Appropriate management of the regional lymphatics, therefore, plays a central role in the treatment of the oral cancer patients. The purposes of this article are to present the history of neck dissections, including current neck dissection classification, describe the technique of the most common neck dissection applicable to oral cavity cancers, and discuss some of the complications associated with neck dissection. Finally, a brief review of elective neck dissection and sentinel lymph node biopsy will be presented. It is necessary that dentists have to be interested in oral cancer and these interest will make it possible to prevent oral cancer, detect it earlier and also improve the prognosis, survival and the quality of life of survivors.

• Korean Journal of Head & Neck Oncology
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• v.26 no.2
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• pp.183-186
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• 2010

Purpose : Papillary thyroid carcinoma (PTC) is known for malignant tumor which has a favorable prognosis and long-term survival. Although the prognosis for patients with PTC is generally good, PTC tends to have highly metastatic property. The purpose of this study was to analyze the central compartment lymph node in papillary thyroid cancer with no lymph node metastasis clinically and to assess the significance of prophylactic node dissection. Methods : A retrospective review was carried out in 394 patients with PTC who underwent surgery for the period from January 2004 to December 2006. The positive rate of the lymph node metastasis was analyzed. The relations between the central compartment lymph nodes and the patients' age, gender, tumor size, exrathyroidal extension(ETE), multifocality, and bilaterality were comparatively analyzed in PTC patients with preoperative no lymph node metastasis. Results : The enrolled patients were 40 male and 354 female cases. The 118 cases of them were found to have cervical lymph node metastasis. The mean age was 46 years(range, 15-77years). Tumor size(p=0.000), ETE(p=0.001), multifocality(p=0.014), and bilaterality(p=0.001) were significantly related factors for cervical lymph node metastasis clinically in papillary thyroid cancer. However, age and gender were not significantly related with lymph node metastasis. Conclusion : Although no lymph node metastasis clinically, prophylactic neck node dissection can be performed to avoid risks of local recurrence and reoperation in the light of PTC nature. The pathological status and high positive rate of central compartment lymph node relate to tumor size and extrathyroidal extension. Close surveillance for nodal status is required in follow-up.

• Korean Journal of Head & Neck Oncology
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• v.20 no.1
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• pp.58-61
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• 2004

Lymph node metastasis of thyroid cancer occurs to anterior compartment (level VI) and superior mediastinal lymph node (Level VII). In lateral neck, it occurs commonly in middle and lower jugular lymph node (level III, IV). And it can also metastasis to posterior neck lymph node (level V). Superior mediastinal lymph node metastasis of thyroid cancer requires superior mediastinal dissection with massive removal of peritracheal and periesophageal soft tissue. After superior mediastinal dissection, severe complication may occurs such as innominate artery rupture and tracheal necrosis. We describe a case of tracheal necrosis as a complication of superior mediastinal dissection and total thyroidectomy in thyroid cancer patient.

• Korean Journal of Head & Neck Oncology
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• v.17 no.1
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• pp.8-12
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• 2001

It is well established that cervical lymph node metastasis is the base of clinical study on head and neck cancer. But few studies have been reported on lymph node metastasis of head and neck cancer in Korea. We consider it essential that studies on cervical lymph node metastases are conducted on pathologically proven database. Therefore, We must have database and consitent system for documentation and data collection of neck dissection specimen for prospective and retrospective study. Herein, We suggest several points from our experiences performing the proper data collection and documentation of neck dissection specimen.