Autoři prezentují případ chylózního ascitu, který vznikl po roboticky asistované retroperitoneální lymfadenektomii. Po neúspěšné konzervativní léčbě byla provedena intranodální lymfografie olejovou kontrastní látkou. Po lymfografii došlo k zástavě tvorby ascitu. Danou kazuistikou chceme poukázat na možnost léčby postoperačního chylózního

The authors present a case of chylous ascites that developed after robot-assisted retroperitoneal lymphadenectomy. The intranodal lymphography with an oil-based contrast media was performed due to unsuccessful conservative treatment. After the lymphography chylous ascites ceased. This case report shows the possibility of treating postoperative chylous ascites with a radiological mini-invasive method.

• MeSH
• chylózní ascites * etiologie   terapie   MeSH
• lidé MeSH
• lymfadenektomie škodlivé účinky   MeSH
• lymfatický systém diagnostické zobrazování   MeSH
• lymfografie * metody   MeSH
• miniinvazivní chirurgické výkony metody   MeSH
• pooperační komplikace terapie   MeSH
• roboticky asistované výkony * metody   MeSH
• Check Tag
• lidé MeSH

CONTEXT: Symptomatic lymphocele (sLC) occurs at a frequency of 2-10% after robot-assisted radical prostatectomy (RARP) with pelvic lymph node dissection (PLND). Construction of bilateral peritoneal interposition flaps (PIFs) subsequent to completion of RARP + PLND has been introduced to reduce the risk of lymphocele, and was initially evaluated on the basis of retrospective studies. OBJECTIVE: To conduct a systematic review and meta-analysis of only randomized controlled trials (RCTs) evaluating the impact of PIF on the rate of sLC (primary endpoint) and of overall lymphocele (oLC) and Clavien-Dindo grade ≥3 complications (secondary endpoints) to provide the best available evidence. EVIDENCE ACQUISITION: In accordance with the Preferred Reporting Items for Meta-Analyses statement for observational studies in epidemiology, a systematic literature search using the MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE databases up to February 3, 2023 was performed to identify RCTs. The risk of bias (RoB) was assessed using the revised Cochrane RoB tool for randomized trials. Meta-analysis used random-effect models to examine the impact of PIF on the primary and secondary endpoints. EVIDENCE SYNTHESIS: Four RCTs comparing outcomes for patients undergoing RARP + PLND with or without PIF were identified: PIANOFORTE, PerFix, ProLy, and PLUS. PIF was associated with odds ratios of 0.46 (95% confidence interval [CI] 0.23-0.93) for sLC, 0.51 (95% CI 0.38-0.68) for oLC, and 0.41 (95% CI 0.21-0.83) for Clavien-Dindo grade ≥3 complications. Functional impairment resulting from PIF construction was not observed. Heterogeneity was low to moderate, and RoB was low. CONCLUSIONS: PIF should be performed in patients undergoing RARP and simultaneous PLND to prevent or reduce postoperative sLC. PATIENT SUMMARY: A significant proportion of patients undergoing prostate cancer surgery have regional lymph nodes removed. This part of the surgery is associated with a risk of postoperative lymph collections (lymphocele). The risk of lymphocele can be halved via a complication-free surgical modification called a peritoneal interposition flap.

• MeSH
• lidé MeSH
• lymfadenektomie škodlivé účinky   metody   MeSH
• lymfokela * epidemiologie   etiologie   chirurgie   MeSH
• nádory prostaty * patologie   MeSH
• prostatektomie škodlivé účinky   metody   MeSH
• randomizované kontrolované studie jako téma MeSH
• robotika * MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• přehledy MeSH
• systematický přehled MeSH

To evaluate the oncological outcomes and safety of primary retroperitoneal lymph node dissection (RPLND) in patients with clinical stage (CS) II seminomatous testicular germ cell tumor (TGCT). A literature search using PubMed, Scopus, and Cochrane Library was conducted on July 2023 to identify relevant studies according to the Preferred Reporting Items for Systematic Review and Meta Analysis (PRISMA) guidelines. The pooled recurrence rate and treatment-related complications were calculated using a random effects model. Overall 8 studies published between 1997 and 2023 including a total of 355 patients were selected for systematic review and meta-analysis with the overall median follow-up of 38 months. The overall and infield recurrence rate were 0.14 (95% CI: 0.08-0.22) and 0.04 (95% CI: 0.00-0.11), respectively. The overall pooled rate of ≥ Clavien Dindo grade III complications was 0.04 (95% CI: 0.01-0.10); there was no significant heterogeneity (I^2 = 35.10%, P = 0.19). Antegrade ejaculation was preserved with the overall pooled rate of 0.98 (95% CI: 0.95-1.00); there was no significant heterogeneity on Chi-square and I2 tests (I^2 = 0.00%, P = 0.58). Primary RPLND is a safe and effective treatment option for patients with CS II seminomatous TGCT resulting highly promising cure rates combined with low treatment-associated adverse events, at medium-term follow-up. However, owing to the lack of comparative studies to the current standard of care and the limited follow-up, individual decision must be made with the informed patient in a shared decision process together with a multidisciplinary team.

• MeSH
• germinální a embryonální nádory * chirurgie   patologie   MeSH
• lidé MeSH
• lymfadenektomie škodlivé účinky   metody   MeSH
• retroperitoneální prostor patologie   MeSH
• retrospektivní studie MeSH
• seminom * patologie   MeSH
• staging nádorů MeSH
• testikulární nádory * patologie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• přehledy MeSH
• systematický přehled MeSH

BACKGROUND: Symptomatic lymphoceles present the most common complication of robot-assisted radical prostatectomy (RARP) with extended pelvic lymph node dissection (ePLND). No surgical technique has so far shown success in reducing the incidence rate, but several retrospective studies have shown the beneficial effect of the fixation of the peritoneum. OBJECTIVE: To introduce a modification in the technique of fixing the peritoneum to the pubic bone and to confirm whether this intervention reduces the incidence of lymphoceles. DESIGN, SETTING, AND PARTICIPANTS: A prospective randomized (1:1) single-center one-sided blind study was conducted in patients with localized prostate cancer (cT1-2cN0M0) indicated for RARP with ePLND operated between December 2019 and June 2021. In the intervention group, the free flap of the peritoneum was fixed to the pubic bone. In the control group, the peritoneal flap was left free without fixation. SURGICAL PROCEDURE: In the intervention group, the free flap of the peritoneum was fixed to the pubic bone (PerFix) so that lateral holes were left, allowing drainage of lymph from the pelvis into the abdominal cavity, where it would be resorbed. The iliac vessels and obturator fossa remained uncovered by the peritoneum and the bladder. MEASUREMENTS: The primary objective was to evaluate the frequency of symptomatic lymphoceles during follow-up. The secondary endpoints were the radiological presence of lymphoceles on computed tomography of the pelvis carried out 6 wk after surgery, the volume of the lymphoceles, and the degree of severe (Clavien-Dindo ≥3) complications. RESULTS AND LIMITATIONS: Of the 260 randomized patients, 245 were evaluated in the final analysis-123 in the intervention and 122 in the control group. The median follow-up was 595 d. There were no differences between the groups regarding clinical and pathological variables. The median of 17 nodes removed was the same in both groups (p = 0.961). Symptomatic lymphoceles occurred in 17 patients (6.9%), while in the intervention group these were found in three (2.4%) versus 14 (11.5%) in the control group (p = 0.011). The number of radiologically detected asymptomatic lymphoceles did not differ (p = 0.095). There was no significant difference in lymphocele volume between the two groups (p = 0.118). The rate of serious complications (Clavien 3a and 3b) was 4.8% in the intervention group and 9.1% in the control group (p = 0.587). A multivariate logistic regression model of symptomatic lymphocele occurrence was created with significant factors: body mass index (odds ratio [OR] = 1.1, 95% confidence interval [CI] = [1.03, 1.26], p = 0.012) and intervention (OR = 4.6, 95% CI = [1.28, 16.82], p = 0.02). CONCLUSIONS: Fixation of the peritoneum (PerFix) reduced the incidence of symptomatic lymphoceles in RARP with ePLND. We found no difference in the frequency of asymptomatic lymphocele development. The volume of the detected lymphoceles was similar. PATIENT SUMMARY: In this study, we compared the rate of development of postoperative complications using the peritoneal fixation technique with that of a nonfixation control group for robot-assisted radical prostatectomy with extended pelvic lymphadenectomy. Fixation of the peritoneum should obviate the development of severe complications in the postoperative period.

• MeSH
• lidé MeSH
• lymfadenektomie škodlivé účinky   metody   MeSH
• lymfokela * etiologie   prevence a kontrola   MeSH
• nádory prostaty * patologie   MeSH
• pánev patologie   MeSH
• peritoneum patologie   chirurgie   MeSH
• prospektivní studie MeSH
• prostatektomie škodlivé účinky   metody   MeSH
• retrospektivní studie MeSH
• roboticky asistované výkony * škodlivé účinky   metody   MeSH
• robotika * MeSH
• volné tkáňové laloky * patologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

PURPOSE OF REVIEW: To provide a summary of the current literature on salvage lymph node dissection (sLND) in patients with nodal recurrent prostate cancer (PCa) with focus on imaging, the extent of sLND and oncologic outcomes. RECENT FINDINGS: The clinical practice guidelines recommend performing PET/CT in patients with biochemical recurrence (BCR) after primary therapy. PSMA PET/CT has demonstrated superiority over choline PET/CT and MRI, especially at low prostate-specific antigen (PSA) levels. Although the heterogeneity in available literature does not allow standardization of surgical templates for sLND and PET/CT scan can guide the extent of surgical dissection, an anatomically defined extended template is typically considered. Radio-guided surgery (RGS) suggests an improved positive lymph node yield compared with standard sLND. However, long-term data are needed to evaluate the oncologic impact of sLND. The main aims of sLND are to delay recurrence and to postpone the need for systemic therapy. Available evidence suggests that around 40-80% of men can achieve complete biochemical response after sLND and 10-30% remain BCR free after 5 years. Robotic sLND might represent an option to reduce the risk of complications without compromising oncological outcomes; validation in controlled prospective studies is, however, needed. SUMMARY: sLND is a valid treatment option for patients with nodal recurrence only after primary therapy for PCa. Further optimization of patient selection based on highly sensitive and specific imaging and clinical factors remains an unmet need. To maximize the benefit of this approach, sLND should be discussed with patients who harbor lymph node-only recurrence after primary therapy in a shared decision-making.

• MeSH
• lidé MeSH
• lokální recidiva nádoru patologie   MeSH
• lymfadenektomie škodlivé účinky   metody   MeSH
• nádory prostaty * diagnostické zobrazování   chirurgie   patologie   MeSH
• PET/CT * metody   MeSH
• prospektivní studie MeSH
• prostatektomie MeSH
• záchranná terapie metody   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

PURPOSE OF REVIEW: Although lymph node dissection (LND) during radical nephroureterectomy (RNU) is recommended for high-risk nonmetastatic upper tract urothelial carcinoma (UTUC), adherence to guidelines remains insufficient in clinical practice. Therefore, this review aims to comprehensively summarize the current evidence regarding the diagnostic, prognostic, and therapeutic impact of LND during RNU in UTUC patients. RECENT FINDINGS: Clinical nodal staging using conventional CT scan has low sensitivity (25%) and diagnostic accuracy [area under the curve (AUC): 0.58] in UTUC, suggesting the importance of LND for obtaining accurate N-staging. Patients with pathological node-positive (pN+) disease have poor disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) compared with those with pN0. In addition, population-based studies showed that patients who underwent LND improved CSS and OS than those who did not, even in patients who received adjuvant systemic therapy. The number of lymph nodes removed has also been shown to be associated with improved CSS and OS, even in pT0 patients. Template-based LND should be performed as the extent of lymph node is more important than the number of lymph nodes. Robot-assisted RNU may facilitate performing a meticulous LND compared with a laparoscopic approach. Postoperative complications such as lymphatic and/or chylous leakage are increased but adequately manageable. However, the current evidence is not supported by high-quality studies. SUMMARY: Based on the published data, LND during RNU is a standard procedure for high-risk nonmetastatic UTUC, owing to its diagnostic, staging, prognostic, and, potentially, therapeutic benefits. Template-based LND should be offered to all patients who are planned for RNU for high-risk nonmetastatic UTUC. Patients with pN+ disease are optimal candidates for adjuvant systemic therapy. Robot-assisted RNU may facilitate meticulous LND compared with laparoscopic RNU.

• MeSH
• karcinom z přechodných buněk * patologie   MeSH
• lidé MeSH
• lymfadenektomie škodlivé účinky   metody   MeSH
• lymfatické uzliny diagnostické zobrazování   chirurgie   patologie   MeSH
• nádory močového měchýře * patologie   MeSH
• nádory močovodu * chirurgie   MeSH
• nefroureterektomie metody   MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

OBJECTIVE: Optimal management of the contralateral groin in patients with early-stage vulvar squamous cell carcinoma (VSCC) and a metastatic unilateral inguinal sentinel lymph node (SN) is unclear. We analyzed patients who participated in GROINSS-V I or II to determine whether treatment of the contralateral groin can safely be omitted in patients with a unilateral metastatic SN. METHODS: We selected the patients with a unilateral metastatic SN from the GROINSS-V I and II databases. We determined the incidence of contralateral additional non-SN metastases in patients with unilateral SN-metastasis who underwent bilateral inguinofemoral lymphadenectomy (IFL). In those who underwent only ipsilateral groin treatment or no further treatment, we determined the incidence of contralateral groin recurrences during follow-up. RESULTS: Of 1912 patients with early-stage VSCC, 366 had a unilateral metastatic SN. Subsequently, 244 had an IFL or no treatment of the contralateral groin. In seven patients (7/244; 2.9% [95% CI: 1.4%-5.8%]) disease was diagnosed in the contralateral groin: five had contralateral non-SN metastasis at IFL and two developed an isolated contralateral groin recurrence after no further treatment. Five of them had a primary tumor ≥30 mm. Bilateral radiotherapy was administered in 122 patients, of whom one (1/122; 0.8% [95% CI: 0.1%-4.5%]) had a contralateral groin recurrence. CONCLUSION: The risk of contralateral lymph node metastases in patients with early-stage VSCC and a unilateral metastatic SN is low. It appears safe to limit groin treatment to unilateral IFL or inguinofemoral radiotherapy in these cases.

• MeSH
• biopsie sentinelové lymfatické uzliny MeSH
• lidé MeSH
• lokální recidiva nádoru patologie   MeSH
• lymfadenektomie škodlivé účinky   MeSH
• lymfadenopatie * patologie   MeSH
• lymfatické metastázy patologie   MeSH
• lymfatické uzliny patologie   chirurgie   MeSH
• nádory vulvy * patologie   MeSH
• sentinelová uzlina * patologie   chirurgie   MeSH
• spinocelulární karcinom * patologie   MeSH
• třísla MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

The aim of the study was to map the lymphatic drainage of the upper extremity that traverses the axilla and elucidate its relationship with the lymphatic drainage of the breast. In 79 breast cancer patients indicated to the axillary lymph node dissection for category cN1, cN2, Technetium-99m (particle size <80 nm) was applied prior to surgery at two injection sites between the second and third metacarpophalangeal joints to visualize upper extremity lymphatics. During the surgery, the axilla was anatomically divided into 6 quadrants. A C-Trak® device was used for the intraoperative detection of radioactivity. After verifying activity, the nodes were resected and their position was recorded. Active nodes were sent separately according to topographic localizations for microscopic examination. All affected nodes (both macro- and micrometastases) were recorded as positive. The location, involvement and radioactivity, and the number of lymph nodes obtained were analyzed. In total, 1,109 lymph nodes were removed and examined. Radioactive nodes were found in all 79 patients. A total of 230 radioactive nodes were found. 21 nodes were both radioactive and metastatically affected. Results show that part of the lymph from the upper extremity flows through the nodes in the central part of the axilla and mixes with the lymph from the breast. This suggests that lymphatic drainage of the upper limb cannot be functionally separated from lymphatic drainage of the breast. The results also explain the possible mechanical cause of arm lymphedema after sentinel lymph node biopsy.

• MeSH
• axila patologie   MeSH
• biopsie sentinelové lymfatické uzliny škodlivé účinky   metody   MeSH
• lidé MeSH
• lymfadenektomie škodlivé účinky   MeSH
• lymfatické uzliny patologie   chirurgie   MeSH
• lymfedém * etiologie   patologie   chirurgie   MeSH
• mastektomie škodlivé účinky   MeSH
• nádory prsu * patologie   chirurgie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Radikální prostatektomie (RP) s rozšířenou pánevní lymfadenektomií (ePLND) představuje standardní terapii středně a vysoce rizikového lokalizovaného karcinomu prostaty (PCa). Využití ePLND v poslední době narůstá díky provádění většího množství RP u agresivnějších nádorů. Jednou z častých komplikací této operace je vznik symptomatických lymfokél, který se udává až u 10 % operovaných. Dosud, i přes rozsáhlý výzkum, nebyla nalezena vhodná strategie, jak předejít této komplikaci. Jednou z potenciálně úspěšných intervencí se zdá být fixace volného listu peritonea při provádění transperitoneální RP. Několik retrospektivních klinických studií prokázalo snížení výskytu symptomatických lymfokél při fixování peritonea k měchýři nebo stěně pánve, čímž je ponechána mezera v peritoneu, která vytvoří cestu pro volný pohyb lymfy z pánevní oblasti do peritoneální dutiny a její následnou resorpci. Jediná dosud publikovaná randomizovaná studie však tuto hypotézu nepotvrdila. Cílem tohoto článku je představit přehled dosud publikovaných klinických studií zabývajících se fixací peritonea.

Radical prostatectomy (RP) with extended pelvic lymph node dissection (ePLND) is currently a standard of care of intermediate and high-risk localized prostate cancer (PCa). The utilization of ePLND is increasing due to stage migration towards more aggressive cancer. Symptomatic lymphoceles, with incidence ranging up to 10 %, are one of the most frequent complications of ePLND. No successful strategy on how to prevent their occurrence has been found so far. One of the promising interventions could be peritoneal flap fixation during transperitoneal RP. Several retrospective studies have shown a reduction in the incidence of symptomatic lymphocele. The peritoneum can be fixed to the urinary bladder or to the pelvic wall leaving a window in the peritoneum that presents a pathway that directs the lymphatic fluid out of the pelvis into the peritoneal cavity where it can be absorbed. The only randomized trial published so far, however, did not show any benefit. This article aims to present an overview of published clinical studies on the fixation of the peritoneum.

• Klíčová slova
• fixace peritonea,
• MeSH
• lidé MeSH
• lymfadenektomie * metody   škodlivé účinky   MeSH
• lymfokela * etiologie   prevence a kontrola   MeSH
• nádory prostaty chirurgie   MeSH
• prostatektomie metody   škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

PURPOSE: The Groningen International Study on Sentinel nodes in Vulvar cancer (GROINSS-V)-II investigated whether inguinofemoral radiotherapy is a safe alternative to inguinofemoral lymphadenectomy (IFL) in vulvar cancer patients with a metastatic sentinel node (SN). METHODS: GROINSS-V-II was a prospective multicenter phase-II single-arm treatment trial, including patients with early-stage vulvar cancer (diameter < 4 cm) without signs of lymph node involvement at imaging, who had primary surgical treatment (local excision with SN biopsy). Where the SN was involved (metastasis of any size), inguinofemoral radiotherapy was given (50 Gy). The primary end point was isolated groin recurrence rate at 24 months. Stopping rules were defined for the occurrence of groin recurrences. RESULTS: From December 2005 until October 2016, 1,535 eligible patients were registered. The SN showed metastasis in 322 (21.0%) patients. In June 2010, with 91 SN-positive patients included, the stopping rule was activated because the isolated groin recurrence rate in this group went above our predefined threshold. Among 10 patients with an isolated groin recurrence, nine had SN metastases > 2 mm and/or extracapsular spread. The protocol was amended so that those with SN macrometastases (> 2 mm) underwent standard of care (IFL), whereas patients with SN micrometastases (≤ 2 mm) continued to receive inguinofemoral radiotherapy. Among 160 patients with SN micrometastases, 126 received inguinofemoral radiotherapy, with an ipsilateral isolated groin recurrence rate at 2 years of 1.6%. Among 162 patients with SN macrometastases, the isolated groin recurrence rate at 2 years was 22% in those who underwent radiotherapy, and 6.9% in those who underwent IFL (P = .011). Treatment-related morbidity after radiotherapy was less frequent compared with IFL. CONCLUSION: Inguinofemoral radiotherapy is a safe alternative for IFL in patients with SN micrometastases, with minimal morbidity. For patients with SN macrometastasis, radiotherapy with a total dose of 50 Gy resulted in more isolated groin recurrences compared with IFL.

• MeSH
• časové faktory MeSH
• dávka záření * MeSH
• lidé středního věku MeSH
• lidé MeSH
• lymfadenektomie * škodlivé účinky   mortalita   MeSH
• lymfatické metastázy MeSH
• mikrometastázy MeSH
• nádory vulvy mortalita   patologie   terapie   MeSH
• prospektivní studie MeSH
• senioři MeSH
• sentinelová uzlina patologie   účinky záření   chirurgie   MeSH
• staging nádorů MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze II MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• webové vysílání MeSH