Lymph node surgery in XXXX .

@entity3557 @entity1 @entity66 @entity5 @entity17470 @entity2802 @entity3944
BACKGROUND: The impact of @entity66 remains controversial in @entity3557 ( @entity3557 ). STUDY DESIGN: One surgeon treated 159 unselected @entity1 , who were followed up for 1 to 27 years. We present a retrospective analysis with respect to @entity66 . @entity66 was investigated, including metachronous @entity66 (mpN(1)) in primarily node negative @entity1 (pN(0), clinical [c]N(0)). RESULTS: Therapeutic lymphadenectomies, prophylactic lymphadenectomies, or no lymphadenectomy were carried out in 42 ( @entity17470 ), 29 (cN(0)), and 88 (cN(0)) @entity1 , respectively, with stage pN(1) in 41 (98%), in 5 (17%), and in 2 (2.3%) @entity1 , respectively (17% versus 2.3% p < 0.005). Sensitivity and specificity of clinical staging were 85% and 99%, respectively. More frequent prophylactic lymphadenectomy during the study period (p = 0.002) led to a nonsignificant increase in stage pN(1) (26% versus 30%). Immunohistochemistry led to upstaging of only 3% of histologically negative nodes and one (4%) pN(0) @entity1 . Nodal recurrence occurred in 8 of 156 @entity1 (5%) treated for cure, in 12% of pN(1) versus 3% of pN(0) cN(0) @entity5 (p = 0.009), in 15% of @entity2802 high-versus 3% of low-risk @entity1 (p = 0.006), and in 5% each of @entity1 , younger than 45 and 45 years or more. In @entity2802 high-risk @entity1 , @entity5 -related survival was 50% for stage pN(1) versus 86% for stage pN(0), cN(0) (p = 0.03) (100% and 100% in low-risk @entity1 ). CONCLUSIONS: The rate of occult @entity66 might be relatively low, and it does not frequently progress to clinical recurrent disease. Clinical nodal status might be valid for deciding the extent and radicality of node dissection. Prophylactic (central) lymphadenectomy should be carried out without radicality-associated morbidity. Macroscopic @entity66 warrants more rigorous, compartment-oriented lymphadenectomy. There is no rationale for detection of occult disease and @entity3944 by frozen section or immunohistochemistry.
