Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Curettage of lymph nodes in 36 patients with cancer of the thoracic esophagus was performed in the bilateral supraclavicular, right intrathoracic and abdominal regions. The overall metastatic ratio in lymph nodes was 52.8 percent (19 of 36). It was particularly high in the right supraclavicular nodes (26.7 percent), the paracardial (27.8 percent) nodes, and nodes of the arch of the left gastric artery (19.4 percent) and the celiac axis (16.7 percent). Metastatic lesions were limited to the intrathoracic lymph nodes in 1 of 19 patients with positive nodal metastasis and were accompanied by metastases of the supraclavicular or abdominal nodes in the other 18 patients. In eight (88.9 percent) of nine patients in whom intrathoracic nodal metastases were confirmed, the supraclavicular or abdominal lymph nodes were involved by metastatic lesions. On the other hand, jumping metastasis to the neck or the abdominal lymph nodes without intrathoracic involvement was observed in 27.8 percent.
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PMID:Lymph node metastases in cancer of the thoracic esophagus. 745 40

Serial histological assays of lymph nodes removed during extensive lymphadenectomy not infrequently reveal metastases, in case of gastric cancer, in paraaortic lymph nodes and the nodes located along the celiac trunk, splenic and hepatic vessels. Among 35 patients 19 showed metastases in these nodes. Metastases were detected also in cases when lymphnodes of these collectors seem to be intact (in8 of 23 patients). Routine lyphadenectomy is unlikely to be considered radical. A total of 112 operations with extensive lymphadenectomy have been performed: gastrectomy (84), distal resection (12), proximal resection (13), extirpation of the gastric stump (3). Of special value is transabdominal approach associated with instrumental correction by dilators attached to an operating table (the technic suggested by M. Z. Sigal). The technic of this operation is described. A total mortality rate was 14.3%. There were no lethal complications due to lymphadenectomy. It seems rational to revise the currently used estimates of the degree of radicality of lymphadenectomy in gastric cancer.
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PMID:[Extensive lymphadenectomy in operations for stomach cancer]. 746 26

In the area of radical surgical treatment of gastric carcinoma, extended or multiorgan resection is--as is systematically extended lymph node dissection--becoming increasingly important. One indication for extended gastrectomy is intramural or transmural infiltration of neighboring organs or the gross presence of metastatic involvement of the lymph nodes associated with the celiac trunk, splenic artery, or splenic hilum. Because the mortality rate associated with extended gastrectomy is hardly any higher than that for nonextended gastrectomy, the indication for the former may be generously applied. The prognostically most unfavorable case is histologic evidence of transmural infiltration of neighboring organs (pT4). Multiorgan resection with improved systematic extension of lymph node dissection is of greatest benefit to patients with inflammatory adhesion of the stomach to neighboring organs or pN2 lymph node metastases. Intramural infiltration of the esophagus can be treated by including the thoracic part of the esophagus in the gastric resection done via an abdominothoracic approach, ensuring an appropriate margin of clearance, with no significant worsening of the prognosis.
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PMID:Extended gastrectomy: who benefits? 767 97

Forty-one patients with either stenosing esophageal and cardia carcinoma (n = 27) or suspected tumor stenosis (n = 14), in whom conventional endosonography had failed, were evaluated with the ultrasonic esophagoprobe (blind probe). The main indication was locoregional staging of esophageal and cardia carcinomas, or restaging after radiotherapy or combined chemotherapy and radiotherapy. In 37% of the patients (10 of 27) an EUS T4 carcinoma was diagnosed, and in 63% (17/27) an EUS-T3 one. Regional lymph-node metastases were diagnosed in 96% of the cases. EUS restaging after nonsurgical palliative treatment detected tumor lesions in three of eight patients. Despite the fact that the imaging quality is still not satisfactory, our results suggest that the limitations of endoscopic ultrasonography (EUS) examination due to stenosing tumor growth can be overcome by the use of this ultrasonic esophagoprobe or similar instruments. Further technical developments may improve the resolution as well as the imaging quality in the celiac axis region.
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PMID:Endoscopic ultrasonography with the ultrasonic esophagoprobe. 771 1

In gastric cancer, retrogastric invasion or enlarged lymph nodes in the hilus of the spleen or at the celiac trunk can readily visualized with laparoscopic ultrasound examination (LUS). Invasion or metastases of the liver can be identified which are "invisible" with the "classic" imaging methods. In our series this led to revision of the TNM staging in 8% of 111 patients with advanced gastric carcinoma. In the staging of early pancreas cancer the standard methods of investigation, including ERCP, are unsatisfactory. Tumor localization, invasion of blood vessels and local or distal lymph node metastases cannot always be evaluated reliably. LUS promises to provide this valuable information. In carcinoma of the distal esophagus or the cardia, LUS can help to exclude small liver metastases, assess invasion of the diaphragm and evaluate the extent of enlarged intraabdominal lymph nodes, especially those at the celiac trunk. A frequent challenge/task for LUS is the exact determination of the benign or malignant nature of liver foci. Quite commonly they are inaccessible to percutaneous CT-guided puncture, but can be easily reached and biopsied under direct vision or LUS-guidance. By virtue of LUS and its information about extrahepatic lymph node infliction, diagnostic laparoscopy is now a less invasive but equally valid substitute for diagnostic laparotomy prior to liver transplantation in oncological diseases. LUS is now well established in diagnostic laparoscopy as a reliable tool for the preoperative staging of distal esophageal and abdominal tumors. It provides additional information which cannot be obtained with conventional imaging procedures.
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PMID:[The technique of laparoscopic ultrasound study in diagnostic laparoscopy]. 793 85

The operative specimens from 43 patients undergoing en bloc esophagectomy for adenocarcinoma of the lower esophagus or cardia were analyzed. Depth of invasion of the tumor and extent and location of lymph node metastases were determined. Postoperative recurrence was identified from positive findings on successive 3-month computed tomographic scans. Positive nodes occurred in 33% (2/6) of intramucosal tumors, 67% (6/9) of intramural tumors, and 89% (25/28) of transmural tumors (p < 0.01). Commonly involved nodes were those in the lesser curve of the stomach (42%), parahiatal nodes (35%), paraesophageal nodes (28%), and celiac nodes (21%). Excluding perioperative deaths, follow-up was complete for 38 patients. Twenty patients had recurrence. Fifteen patients (40%, 15/38) had nodal recurrence: cervical, 7.9% (3/38); superior mediastinal, 21% (8/38); and abdominal, 24% (9/38) (retropancreatic in 7 and retrocrural in 2). Of 5 patients with nodal recurrence alone, 3 (60%) had recurrence at sites outside the margins of resection. Patients with four metastatic nodes or less had a survival advantage over those with more than four (p < 0.05). There was no difference in survival according to location of nodal metastases. Two (22.2%) of 9 patients with celiac node metastases survived longer than 4 years. Adenocarcinoma of the lower esophagus and cardia spreads widely to mediastinal and abdominal nodes, and death can occur from nodal disease. Rates of lymph node metastases increase with the depth of the primary tumor. Patients with lymphatic metastases can be cured particularly if there are fewer than four nodes involved. Curative surgical therapy necessitates wide lymph node resection to ensure removal of all metastatic nodes.
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PMID:Nodal metastasis and sites of recurrence after en bloc esophagectomy for adenocarcinoma. 794 84

Thirty-two consecutive patients with esophageal carcinoma (squamous cell carcinoma: 23, adenocarcinoma: 9) were pre-operatively examined by endoscopic ultrasonography (EUS) in order to evaluate the accuracy of this diagnostic procedure in loco-regional staging. Six patients were not operated on, due to a poor general conditions or widespread tumor disease and were not included in this study. Results of EUS staging from the remaining patients were compared with intra-operative exploration and histopathological evaluation of resection specimens. Seven stenosing tumors were not traversable by echoendoscope. In such cases the lesion was visualized only in part by scanning the top of the stenosis. The overall EUS accuracy in T staging was 80.7% (75% in T2 stage, 90.9% in T3, 71.4% in T4). Three tumors were overstaged; two not traversable stenosing tumors were understaged. The overall accuracy in N staging was 73% (sensitivity 77.7%, specificity 62.5%). For celiac nodes EUS sensitivity was only 57.1%. Authors conclude that the presence of a not traversable stenosis is still a limit for EUS in diagnosing infiltration of adjacent structures as well as in detecting lymph node metastases.
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PMID:[Endoscopic ultrasonography in preoperative staging of esophageal cancer]. 800 Nov 94

The range of lymph node dissection in 226 cases of thoracic and abdominal esophageal carcinoma was investigated with reference to the relation between nodal metastasis and location of carcinoma. Subgroups of Iu (the upper third), Im (the middle third) and E (the lower third of thoracic esophagus plus abdominal esophagus) were defined as localized Iu (n = 10) and IuIm (n = 7); ImIu (n = 21), localized Im (n = 66), ImE (n = 34) and extensive Im (n = 6); and EIm (n = 23) and localized E (n = 59). In cases of Iu, dissection of cervical and upper mediastinal nodes including subaortic nodes was important, because of the high incidence of metastasis to right recurrent nerve nodes and left paratracheal nodes. Dissection of middle mediastinal nodes was also necessary in the IuIm group. Nodal metastases in cases of Im covered in a wide range, but there were some differences in distribution of nodal involvement in the three subgroups. Cervical and upper mediastinal (including subaortic) nodes in the ImIu group, upper mediastinal (excluding subaortic) nodes in the localized Im group and celiac-axis nodes in ImE group were found to have a high incidence of metastasis, while right recurrent nerve nodes and middle and lower mediastinal and upper gastric nodes commonly showed a high metastatic rate in all subgroups. Dissection was found to be essential for this range of lymph nodes, especially, for right recurrent nerve nodes and upper gastric nodes regarded as being affected by metastasis at the early stage.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Strategic lymph node dissection for thoracic and abdominal esophageal carcinoma in relation to nodal metastasis and location of carcinoma--analysis of subgroups carcinoma location]. 803 65

The indication, efficacy, and extent of extended lymphadenectomy for a carcinoma in the thoracic esophagus remain controversial and under clinical investigation. Here we report the frequency and mode of lymph node metastasis at operation and of lymph node recurrence after operation in 70 patients who underwent three-field dissection and 75.7% of whom suffered from metastasis or recurrence in the lymph nodes (metastasis in 71.4% and recurrence in 21.4%). Metastasis or recurrence in the cervical and cervicothoracic nodes were found in 18.6% and 41.4%, respectively. The frequency of cervical and cervicothoracic lymph node metastasis or recurrence was, respectively, 40.0% and 90.0% for a carcinoma in the upper thoracic esophagus, 21.6% and 37.8% for a carcinoma in the middle thoracic esophagus, and 4.3% and 26.1% for a carcinoma in the lower thoracic esophagus. Lymph node metastasis at operation was most frequently found in the right recurrent nerve nodes, right paracardiac nodes, periesophageal nodes, and lesser curvature nodes, whereas lymph node recurrence after operation was found in the left upper recurrent nerve nodes and the right supraclavicular, celiac, and abdominal paraaortic nodes. Metastasis or recurrence was rarely found in the internal jugular, pretracheal, greater curvature, common hepatic, or splenic nodes. This finding suggests the need for recurrent nerve node dissection for all cases and for three-field dissection for a carcinoma in the upper or middle thoracic esophagus.
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PMID:Lymph node metastasis and recurrence in patients with a carcinoma of the thoracic esophagus who underwent three-field dissection. 804 33

The utility of computed tomography in pretherapy assessment of esophageal carcinoma is reviewed. Computed tomographic findings in 78 patients with histologically proved esophageal carcinoma were corelated with findings at surgery and histopathology. Computed tomography (CT) was found to be fairly accurate in assessing tumor extent, invasion of adjacent mediastinal structures and distant metastases but was of no help in detecting periesophageal lymph node involvement. The tracheobronchial tree invasion was detected with an overall accuracy of 96% whereas the same for invasion of aorta, percardium and gastroesophageal junction was 86%, 88% and 78% respectively. The sensitivity for the detection of periesophageal and perigastric lymphadenopathy was low (9% and 0% respectively) but was acceptably high in celiac lymphadenopathy (70%). CT is an excellent non invasive modality in pretherapy assessment of esophageal carcinoma and can guide the surgeon in determining the appropriate therapy.
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PMID:Role of computed tomography in preoperative evaluation of esophageal carcinoma. 806 30


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