No abstract

No abstract

Background: Lymphedema may develop when axillary lymph node dissection (ALND) injures and obstructs the lymph ducts in the upper limb. In patients with breast cancer, lymphedema is difficult to treat and can cause arm swelling, heaviness, and restricted movement. We aimed to identify the prevalence and risk factors for lymphedema after ALND in patients with breast cancer. Methods and Results: This retrospective study included 175 patients with breast cancer who underwent ALND in the Nagasaki University Hospital, Japan, between 2005 and 2018. Lymphedema was defined as symptomatic arm swelling with a >2-cm difference in the arm circumference between the affected and contralateral arms. Patients were divided into two groups according to the presence or absence of lymphedema. Surgical and pathological findings were compared between the two groups. Univariate and multivariate analyses were performed, including the chi-square test, Student's t -test, and logistic regression analysis. Lymphedema was prevalent in 20% of the study participants, and the mean time interval from surgery to development of lymphedema was 479 days. In the univariate analysis, a body mass index of >26 kg/m 2 , smoking, radiotherapy (RT), and dissection of >18 axillary lymph nodes (ALNs) significantly increased the risk of lymphedema. In the multivariate analysis, smoking, RT, and dissection of >18 ALNs significantly increased the risk of lymphedema. Conclusions: The prevalence of lymphedema in our study was 20%. Our findings suggest that smoking, RT, and dissection of >18 ALNs are risk factors for lymphedema. Aggressive and empiric ALND might be associated with axillary lymph duct damage.

No abstract

Background The survival rate of patients with hepatoblastoma (HB) with distant metastases is unsatisfactory. Although dose-dense chemotherapy with a high incidence of ototoxicity improves the prognosis of these patients, surgical metastasectomy may provide an alternative treatment option avoiding drug side effects. The aim of this study was to examine the efficacy of “complete” pulmonary metastasectomy for the treatment of children with metastatic HB. Methods This retrospective study retrieved data from 2004 to 2015 on 22 children with metastatic HB. Separated into two groups; children who underwent only hepatectomy (group H, 14 cases), and children who underwent primary or rescue liver transplantation (group T, eight cases). Each patient was administered initial chemotherapy according to JPLT-2, SIOPEL3 or PLADO protocols. Over the course of this study, we performed metastasectomies for all detectable pulmonary metastases. Indocyanine green fluorescent navigation was used for 15 patients to detect tiny metastases. The follow-up period for survivors after the last metastasectomy ranged from 36 to 186 months. Results The cumulative disease-free 5-year survival rate was 84% in group H and 33% in group T. The median number of resected pulmonary metastatic lesions was 10.5 (range: 1-42) in group H and 3.5 (range: 1–97) in group T. None of the survivors developed hearing or respiratory impairment. Conclusions Complete pulmonary metastasectomy improves the prognosis of patients with metastatic HB with conventional chemotherapy, especially in the patients with primary HB lesions removed without liver transplantation.