• Journal of Chest Surgery
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• 제54권4호
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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.

• Asian Pacific Journal of Cancer Prevention
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• 제14권6호
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• pp.3769-3772
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• 2013

Background: To investigate the impact of the lymph node ratio (LNR) on the prognosis of patients with locally advanced rectal cancer undergoing pre-operative chemoradiation. Methods: Clinicopathologic and follow up data of 128 patients with stage III rectal cancer who underwent curative resection from 1996 to 2007 were reviewed. The patients were divided into two groups according to the lymph node ratio: LNR ${\leq}$ 0.2 (n=28), and >0.2 (n=100). Kaplan-Meier and the Cox proportional hazard regression models were used to evaluate the prognostic effects according to LNR. Results: Median numbers of lymph nodes examined and lymph nodes involved by tumour were 10.3 (range 2-28) and 5.8 (range 1-25), respectively, and the median LNR was 0.5 (range, 0-1.6). The 5-year survival rate significantly differed by LNR (${\leq}$ 0.2, 69%; >0.2, 19%; Log-rank p value < 0.001). LNR was also a significant prognostic factor of survival adjusted for age, sex, post-operative chemotherapy, total number of examined lymph nodes, metastasis and local recurrence (${\leq}$ 0.2, HR=1; >0.2, HR=4.8, 95%CI=2.1-11.1) and a significant predictor of local recurrence and distant metastasis during follow-up independently of total number of examined lymph node. Conclusions: Total number of examined lymph nodes and LNR were significant prognostic factors for survival in patients with stage III rectal cancer undergoing pre-operative chemoradiotherapy.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제34권6호
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• pp.594-601
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• 2008

Cervical lymph node metastasis is one of the most important predicting factors that influence the prognosis of oral squamous cell carcinoma. Correct diagnosis on cervical lymph node metastasis is essential in determining the extent of operation and treatment modality. So we investigated a clinico-statistical evaluation on cervical lymph node metastasis in 183 patients who were diagnosed with oral squamous cell carcinoma at the Department of Oral and Maxillofacial Surgery in Kyungpook National University Hospital, from January 1st, 1999 to December 31st, 2007. The following results were obtained : 1. Among 183 patients who were diagnosed with oral squamous cell carcinoma, 149 were male and 49 were female. The average age of the patients was 61.8 years old. 2. Patients with advanced T classification showed higher incidence of cervical lymph node metastasis than those with lower T classification. 3. Patients with less differentiated tumors had higher tendency of manifesting cervical lymph node metastasis than those with more differentiated tumors. 4. Sensitivity and specificity on PET/CT was 87.5% and 58.3% respectively. PET/CT showed higher sensitivity and lower false-negative values than those of CT or USG. 5. The 5 - year survival rate of all the oral squamous cell carcinoma patients appeared to be 63.2% By N classification, patients in N0 stage showed a higher survival rate than patients in N1 or N2. 5 - year survival rates according to the modality of neck dissection were as follows in increasing order: no neck dissection group, MRND group, SND group, and RND group.

• Toxicological Research
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• 제18권2호
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• pp.175-181
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• 2002

Allergic contact dermatitis (skin sensitization) may be caused by a wide variety of chemicals. A murine local lymph node assay (LLNA) has been developed as an alternative to guinea pig models for assessing the contact sensitization potential of chemical. This study was carried out to evaluate the skin sensitization potential for chemicals in Balb/c mice by LLNA. Contact allergen, dinitrochlorobenzene (DNCB), respiratory allergen, toluene diisocyanate (TDI) and a weak allergen, $\alpha$-hexlycinnamaldehyde (HCA) were wed as positive chemicals and irritant, sodium lauryl sulfate(SLS) also wed as a reference chemical in this study. The weights of lymph node in the mice treated with DNCB, TDI, and HCA were increased compared to vehicle control. There was a significant increase in lymph node weight of mice treated with high concentration of SLS compared to vehicle control. The stimulation index (SI) of Lymph node cell in the mice treated with DNCB, TDI, and HCA revealed over three-fold increase compared to vehicle control by $3^H$-thymidine uptake. All allergens correctly identified in this LLNA study wing Balb/c mice. These results suggest that LLNA wing Balb/c mice could be a useful method for screening the allergenic potential of chemicals. The expression of IL-2 mRNA was slightly increased in draining auricular lymph node cell of the mice treated with TDI and HCA by RT-PCR. However the IL-2 levels in DNCB and SLS of treated animals were not significantly changed.

• 대한두경부종양학회지
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• 제18권1호
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• pp.50-55
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• 2002

Objectives: Thyroid cancer is the most common endocrine malignancy with favorable histologic and prognostic characteristics. Total or near total thyroidectomy has been used as a standard surgical procedure. The aims of this study are to determine the extent of resection of thyroid gland and to find the influencing factors of lymph node metastasis. Materials and Methods: The authors reviewed the records of 194 patients of thyroid cancer surgically treated at Department of General Surgery, Inje University Busan Paik Hospital from January, 1996 to December, 2000. Pathologic classifications, surgical procedures, and lymph node metastasis were analyzed. Results: There were 163 women and 31 men. The age ranged from 12 to 79 years old (mean age 43.2 years). The histological classifications of 194 cases revealed papillary cancer in 171 cases (88.1%), follicular cancer in 17 cases (8.8%), undifferentiated cancer in 3 cases (1.6%), medullary cancer in 2 cases (1.0%) and mixed cancer in 1 case (0.5%). Among the 194 patients, lobectomy was perfomed in 31 patients, subtotal thyroidectomy in 30 patients, near total thyroidectomy in 82 patients and total thyroidectomy in 51 patients. In the subgroup of papillary carcinoma 141 cases with lymph node dissection, lymph node metastasis had no statistical significance according to sex, age and primary tumor size. Conclusions: The mainly performed surgical procedures were total thyroidectomy and near total thyroidectomy. In thyroid cancer surgery, the extent of resection was influenced by age, differentiation and primary tumor size. The lymph node dissection should be decided by lymph node metastasis identified by preoperative radiologic evaluation or intraoperative lymph node findings.

• Asian Pacific Journal of Cancer Prevention
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• 제16권1호
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• pp.271-274
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• 2015

Background: To explore vascular endothelial growth factor C (VEGF-C) and VEGF-D expression and its correlation with lymph node metastasis in esophageal squamous cell cancer (ESCC) tissue. Materials and Methods: Immunohistochemical methods were applied to detect the levels of VEGF-C and VEGF-D expression in 64 surgicall removal ESCC tissues, tissues adjacent to cancer and normal tissues, and the relationship between VEGF-C and VEGF-D expression and lymph node metastasis was analyzed. Results: Both VEGF-C and VEGF-D were expressed by varying degrees in esophageal cancer tissue, the tissue adjacent to cancer and normal tissue, and the positive expression rate went down successively. The positive expression rates of VEGF-C (59.4%) and VEGF-D (43.8%) in esophageal cancer tissue were significantly higher than in the tissue adjacent to cancer (34.4%, 15.6%) and normal tissue (20.3%, 12.5%), respectively, in which significant differences were manifested (p<0.01). Positive expression rates of VEGF-C and VEGF-D in esophageal cancers with lymph node metastasis were markedly higher than without such metastasis (p<0.01), while those in the tissue with TNM staging I~II were markedly lower than that with TNM staging III~IV (p<0.01). Conclusions: Both VEGF-C and VEGF-D are highly expressed in ESCC tissue, which may be related to the lymph node metastasis of cancer cells. Hence, VEGF-C and VEGF-D can be clinically considered as important reference indexes of lymph node metastasis in esophageal cancer.

• Journal of Breast Cancer
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• 제21권4호
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• pp.442-446
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• 2018

Purpose: The definition of nodal pathologic complete response (pCR) after a neoadjuvant chemotherapy (NAC) just included the evaluation of axillary lymph node (ALN) without internal mammary lymph node. This study aimed to evaluate the feasibility of internal mammary-sentinel lymph node biopsy (IM-SLNB) in patients with breast cancer who underwent NAC. Methods: From November 2011 to 2017, 179 patients with primary breast cancer who underwent operation after NAC were included in this study. All patients received radiotracer injection with modified injection technology. IM-SLNB would be performed on patients with internal mammary sentinel lymph node (IMSLN) visualization. Results: Among the 158 patients with cN+ disease, the rate of nodal pCR was 36.1% (57/158). Among the 179 patients, the visualization rate of IMSLN was 31.8% (57/179) and was 12.3% (7/57) and 87.7% (50/57) among those with $cN_0$ and cN+ disease, respectively. Furthermore, the detection rate of IMSLN was 31.3% (56/179). The success rate of IM-SLNB was 98.2% (56/57). The IMSLN metastasis rate was 7.1% (4/56), and all of them were accompanied by ALN metastasis. The number of positive ALNs in patients with IMSLN metastasis was 3, 6, 8, and 9. The pathology nodal stage had been changed from $pN_1/pN_2$ to $pN_{3b}$. The pathology stage had been changed from IIA/IIIA to IIIC. Conclusion: Patients with visualization of IMSLN should perform IM-SLNB after NAC, especially for patients with cN+ disease, in order to complete lymph nodal staging. IM-SLNB could further improve the definition of nodal pCR and guide the internal mammary node irradiation.

• Journal of Digestive Cancer Research
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• 제3권2호
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• pp.108-112
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• 2015

위암의 재발은 환자의 예후를 불량하게 하며, 재발성 위암의 치료 방법은 재발 양상에 따라서 달라질 수 있고, 국내외적으로 항암치료를 제외한 치료 방법에 대해 뚜렷한 지침이 정해져 있지는 않다. 저자들은 근치적 위절제술 시행 후 림프절 전이가 발생한 진행성 위암 환자에서 고식적 항암화학치료와 구제 방사선요법을 시행한 뒤 완전 관해에 도달한 증례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Journal of Genetic Medicine
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• 제20권2호
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• pp.52-59
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• 2023

Purpose: Colorectal cancer (CRC) is a common malignancy worldwide and the second leading cause of cancer-related deaths. In addition, lymph node metastasis in CRC is considered an important prognostic factor for predicting disease recurrence and patient survival. Recent studies demonstrated that the microbiome makes substantial contributions to tumor progression, however, there is still unknown about the microbiome associated with lymph node metastasis of CRC. Here, we first reported the microbial and tumor-infiltrating immune cell differences in CRC according to the lymph node metastasis status. Materials and Methods: Using Next Generation Sequencing data acquired from 368 individuals diagnosed with CRC (N0, 266; N1, 102), we applied the LEfSe to elucidate microbial differences. Subsequent utilization of the Kaplan-Meier survival analysis enabled the identification of particular genera exerting significant influence on patient survival outcomes. Results: We found 18 genera in the N1 group and 3 genera in the N0 group according to CRC lymph node metastasis stages. In addition, we found that the genera Crenobacter (P=0.046), Maricaulis (P=0.093), and Arsenicicoccus (P=0.035) in the N0 group and Cecembia (P=0.08) and Asanoa (P=0.088) in the N1 group were significantly associated with patient survival according to CRC lymph node metastasis stages. Further, Cecembia is highly correlated to tumor-infiltrating immune cells in lymph node metastasized CRC. Concolusion: Our study highlights that tumor-infiltrating immune cells and intratumoral microbe diversity are associated with CRC. Also, this potential microbiome-based oncology diagnostic tool warrants further exploration.

• Asian Pacific Journal of Cancer Prevention
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• 제16권15호
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• pp.6691-6696
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• 2015

Background: Endometrial carcinoma is the most common gynecological cancer and its treatment is still controversial, especially in its early stages. There are conflicting data about the efficacy of retroperitoneal lymphadenectomy during abdominal hysterectomy and bilateral salpingoophrectomy treatment. Lymphadenectomy carries a risk of severe complications, especially in women with co-morbidities. Selective lymphadenectomy has been widely employed for staging evaluation of endometrial carcinoma because it is simple and seems to provide reliable data regarding nodal metastasis. This study was designed to evaluate accuracy of sentinel node sampling in detecting lymph node metastasis in primary endometrial carcinoma during staging laparotomy. Materials and Methods: Ninety-three women with endometrial carcinoma at high-risk for nodal metastasis were studied. During laparotomy, methylene blue dye was injected into sub-serosal myometrium, then retroperitoneal spaces were opened and blue lymph nodes within pelvic and para-aortic regions were removed as separate specimens for histopathological examination (sentinel lymph nodes = SLNs). Hysterectomy and selective lymphadenectomy then performed for all women included in this study. Results: Deposition of methylene dye into at least one lymph node was observed in 73.1% (68/93) of studied cases. 18.3% (17/93) of studied women had positive lymph node metastasis and 94.1% (16/17) of them had positive metastasis in SLNs. In this study, SNLs had 94.4% sensitivity and 100% specificity in prediction of lymph node metastasis. Mean number of lymph nodes removed from each case decreased when SLNs biopsy were taken. Conclusions: SLNs are the key lymph nodes in endometrial tumor metastasis and their involvement could be an indicator for whether or not complete systematic lymphadenectomy is needed during staging laparotomy.