The lymphatic system in thoracic oncology:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia, Pa. [u.a.]
Saunders
2012
|
| Schriftenreihe: | Thoracic surgery clinics
22,2 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | X S., S. 140 - 255 Ill., graph. Darst. |
| ISBN: | 9781455739448 |
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Datensatz im Suchindex
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| adam_text | The Lymphatic System in Thoracic Oncology
Contents
Preface: The Lymphatic System in Thoracic Oncology
ix
Federico
Venuta
and Erino A. Rendina
Anatomy and Physiology of the Thoracic Lymphatic System
139
Matías
Losano Brotons, Ciprian
Bolca,
Éric
Frechette, and
Jean Deslauriers
The thoracic lymphatic system is one of the most complex and poorly understood
systems of the human body, and much is still to be learned, especially in lymphatic
physiology. Knowledge of the normal anatomy of this system as well as of its varia¬
tions is nevertheless important for thoracic surgeons investigating and treating pa¬
tients with lung or esophageal neoplasms.
Computed Tomography and Magnetic Resonance Imaging of the Thoracic
Lymphatic System
155
Maria
Luisa
Mennini, Carlo
Catalano, Maurizio
Del Monte, and Francesco Fraioli
Several
radiographie
diagnostic techniques are currently available to assess the po¬
tential involvement of mediastinal lymph nodes in thoracic oncology. In particular,
computed tomography and magnetic resonance imaging have been repeatedly val¬
idated; these techniques allow adequate imaging with a reasonable accuracy. The
morphologic information provided by these techniques is crucial to stage lung can¬
cer and plan treatment. These techniques are also extremely useful to evaluate other
disorders and differentiate malignancy from benign disease.
PET Staging of Mediastinal Lymph Nodes in Thoracic Oncology
161
Stephen R.
Broderick
and Bryan F. Meyers
There is an extensive and growing body of literature about the role of positron
emission tomography (PET) in the management of non-small cell lung cancer
and esophageal cancer. This article focuses on the use of PET in mediastinal stag¬
ing of these common thoracic malignancies. PET is the most accurate noninvasive
approach to staging mediastinal lymph nodes in non-small cell lung cancer. The
role of PET in mediastinal lymph node staging in esophageal cancer is less clear,
since it has been largely supplanted by
endoscopie ultrasonography. A
review of
the evidence for and against the use of PET in mediastinal staging is provided and
the use of PET in practice is discussed.
MicroRNAs and Lymph Node Metastatic Disease in Lung Cancer
167
Francesco
Fazi
and
Giulia Fontemaggi
Lymphatic and distant
métastases
are primary factors in determining survival
in patients with lung cancer. The identification of novel molecular
biomarkers
that
can predict the presence of micrometastasis in lymph nodes and their incorporation
in traditional
histologie
staging is needed. MicroRNAs are emerging as powerful bio-
markers for several neoplastic disorders. This article reports the experimental results
that have recently led to the identification of several microRNAs deregulated in lung
cancer that are strongly associated with lymph node metastasis and advanced clin¬
ical stage. This evidence indicates that microRNAs are a promising tool for the clin¬
ical management of lung cancer.
Contents
Invasive Staging of Mediastinal Lymph Nodes: Mediastinoscopy and Remediastinoscopy
177
Ramón
Rami-Porta
and
Sergi
Call
Nodal status in lung cancer is essential for planning therapy and assessing progno¬
sis. The involvement of ipsilateral and
contralateral
mediastinal lymph nodes is as¬
sociated with poor prognosis and usually excludes patients from upfront surgical
treatment. Mediastinoscopy is a time-honored procedure that allows the surgeon
to access the upper mediastinal lymph nodes for either biopsy or removal. Reme¬
diastinoscopy is mainly indicated to assess objective tumor response in mediastinal
lymph nodes after induction therapy for locally advanced lung cancer and to indicate
further therapy.
Ultrasound-Guided
Transbronchial
and Transesophageal Needle Biopsy in the
Mediastinal Staging of Lung Cancer
191
Jarosław Kużdżał
and
Artur Szlubowski
This review presents the current state of two endosonographic techniques, endo-
bronchial ultrasonography (EBUS) and
endoscopie ultrasonography
(EUS),
and their
application in the mediastinal staging of patients with lung cancer. The technique for
these procedures is presented and their diagnostic yield is discussed, based on the
published evidence. EBUS and
EUS,
especially in combination with needle aspira¬
tion biopsy, emerge as the primary modalities for mediastinal staging because of
their high diagnostic yield, minimal invasiveness, low cost, and avoidance of disrup¬
tion of mediastinal lymphatic pathways before the final treatment.
Sentinel Lymph Node in Lung Cancer Surgery
205
Franca M.A. Melfi,
Federico Davini,
Giuseppe
Boni,
and Alfredo
Mussi
The greatest utility of sentinel lymph node (SLN) assessment is the avoidance of
lymph node dissection and related morbidity. Another potential utility is the ability
to direct pathologic examination and more sensitive techniques to detect occult
micrometastatic disease. New pathologic methods can identify single tumor cells
or even genetic material within a single lymph node station, bringing the concept of
ultrastaging and micrometastasis in the field on staging. This article describes the
SLN technique in patients with early non-small-cell lung cancer, as unique and useful
targeting enables pathologists to localize micrometastatic foci within an otherwise
normal lymph node.
Thoracoscopic and Robotic Dissection of Mediastinal Lymph Nodes
215
Douglas J. Minnich, Ayesha S. Bryant, and Robert J. Cerfolio
Understanding the anatomy of the lymphatic channels and lymph nodes in the me¬
diastinum is relevant to many disease processes as well as therapeutic interventions
for thoracic malignancies. A brief review of the anatomy of the mediastinal
lymph nodes is presented and the indications for mediastinai lymph node dissection
are discussed, followed by a more detailed description of the technical aspects of
thoracoscopic and robotic mediastinal lymph node dissection.
Video-Assisted Mediastinoscopic Lymphadenectomy and
Transcervical
Extended
Mediastinal Lymphadenectomy
219
Marcin
Zieliriski
This article describes in detail the operative technique of the new surgical methods,
video-assisted mediastinoscopic lymphadenectomy (VAMLA) and
transcervical
Contents
extended mediastinal lymphadenectomy (TEMLA). Both techniques enable the re¬
moval of the mediastinal nodes with the surrounding fatty tissue. VAMLA and TEMLA
have very high diagnostic yield and can be combined with minimally invasive video-
assisted lobectomy.
The Role of Lymphadenectomy in Lung Cancer Surgery
227
Antonio D Andrilli,
Federico
Venuta,
and Erino A, Rendina
Adequate lymphadenectomy represents a fundamental procedure in lung cancer
surgery for accurate staging and potential survival benefit. Various techniques are
used in current surgical practice for the
intraoperative
lymph node removal associ¬
ated with pulmonary resection, without definitive indications concerning the prefer¬
able option. Different studies in the last decades have compared complete
mediastinal lymph node dissection with lymph node sampling regarding their effect
on long-term survival, recurrence rate, accuracy of pathologic staging, and surgical
morbidity. Literature data and technical aspects of lymph node dissection are re¬
ported and discussed in this article.
The Impact of Complete Lymph Node Dissection for Lung Cancer on the
Postoperative Course
239
Hiroshi Date
The role of lymph node dissection (LND) for non-small cell lung cancers (NSCLCs)
remains controversial. LND adds little morbidity to a pulmonary resection for
NSCLC, although it requires an additional
15
to
20
minutes of operative time. Four
prospective randomized trials have been performed to compare lymph node sam¬
pling and LND;
3
trials showed no difference in survival and
1
showed survival ben¬
efit of LND. It is recommended that all patients with resectable NSCLC undergo LND
because the procedure provides patients with the most accurate staging and the op¬
portunity for effective adjuvant therapy.
The Impact of Chemotherapy on the Lymphatic System in Thoracic Oncology
243
Antonio
Pássaro,
Patrizia Trenta, Davide Conte, Giuseppe Campennì,
Angelina
De Benedetto, and Enrico Cortesi
Non-small-cell lung cancer remains the leading cause of cancer-related mortality in
the United States and Europe. Most patients are diagnosed with metastatic disease
for which chemotherapy remains the cornerstone of treatment. In non-metastatic
disease, surgery is the most potentially curative therapeutic option, but its outcome
is still poor, in particular for patients with lymph node involvement. Therefore, several
randomized adjuvant/neoadjuvant trials using chemotherapy and/or radiotherapy
investigated the possibility of increasing the overall survival of patients with surgi¬
cally treated lung cancer. The findings are reviewed in this article.
Index
251
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| title | The lymphatic system in thoracic oncology |
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