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Recurrent laryngeal nerve palsy is one of the most serious complications associated with thyroid cancer surgery. This study aimed to assess the efficacy of intraoperative neural monitoring (IONM) in preventing recurrent laryngeal nerve palsy during thyroid cancer surgery, analyze and elaborate the theory, operation standard, application, benefits and disadvantage based on clinical practice.
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Objective@#To investigate the rationality of management of active surveillance for papillary thyroid microcarcinoma (PTMC) and the main indications for active surveillance for PTMC.@*Methods@#In this study, two criteria were used to evaluate patients with PTMC: low-risk PTMC conditions defined by Kuma hospital and Chinese Association of Thyroid Oncology (CATO) consensus on PTMC management of active surveillance. The patients had received surgical treatment. Clinicopathological characteristics and prognosis of the patients in different groups were compared.@*Results@#A total of 778 patients were enrolled in the study, 565 (72.6%) of them met Kuma screening criteria and only 112 (14.4%) met CATO screening criteria. Kuma low-risk subgroup had lower incidence of cervical lymph node metastasis than Kuma high-risk PTMC subgroup(30.6% vs 47.9%, P<0.05). There were significant differences in multifocal lesions(6.3% vs 16.4%), extrathyroidal extension (1.8% vs 7.5%) and cervical lymph node metastasis(19.6% vs 38.0%) between low-risk and high-risk CATO PTMC subgroups. Patients in the CATO low-risk PTMC subgroup had lower recurrence and longer disease-free survival (DFS) than those in the CATO high-risk PTMC subgroup. But there was no significant difference in recurrence or DFS between Kuma low-risk and high-risk Kuma PTMC subgroups.The Chi-square test of Fisher′s exact probabilities test was used to compare clinicopathological characteristics of patients between different groups.Rates of disease-free survival were calculated using the Kaplan-Meier method.@*Conclusion@#CATO screening criteria is relatively strict and may be more suitable for Chinese patients with active surveillance for PTMC.
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Background and purpose: The aim of this study was to determine the necessity of central compartment neck dissection in laryngeal cancer.Study Design: Retrospective study at a tertiary referral medical center. Methods:Patients with laryngeal squamous cell cancer who underwent neck dissection were evaluated, and a retrospective analysis of clinicopathologic factors and follow-up data were performed. Results: One hundred and eighteen patients from 1999 to 2009 were enrolled. There were 11.9% central compartment lymph node metastasis in all patients, including the 10 patients with central compartment lymph node metastasis in 34 patients underwent compartment neck dissection and 4 patients do not underwent compartment neck dissection but had central neck recurrence in the follow up time. Subglottic or pyriform extension were risk factors in central compartment lymph node metastasis and central neck recurrence (P=0.002). Central compartment lymph node metastasis had closed relationship with levelⅣmetastasis (P<0.001), extracapsular extension (P=0.001), vascular extension (P=0.015) and poor local control rates (P=0.035) respectively. Patients who were positive for lateral neck lymph node metastasis had poor disease-free survival rate (P=0.014) and poor local control rates (P=0.025), and supraglottic cancer had a trend to metastases to levelⅡ(P=0.044). Conclusion:Central compartment neck dissection might be considered a potential therapeutic approach for patients with laryngeal cancer.
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Objective To study the impact of pregnancy on differentiated thyroid cancer. Methods Retrospective comparative analysis were made between pregnancy-related thyroid cancer patients ( including nine months before delivery and one year after delivery) and the age-matched non-pregnancy-related thyroid cancer patients treated in the Department of head and neck, Fudan University Shanghai Cancer Center. Results There were 125 cases of pregnancy-related thyroid cancer patients from 1998 to 2008, including 28 cases (22.4%) of neck recurrence and metastasis after the surgery of thyroid cancer, meanwhile there were 691 cases of the agematched non-pregnancy thyroid cancer patients, including 90 cases ( 13% ) of neck recurrence and metastasis after the surgery of thyroid cancer. The rate of neck recurrence and metastasis after the surgery of thyroid cancer in the pregnancy-related group was higher than that in the non-pregnancy related group ( P ＜ 0.05). The maximum diameter of tumor in the pregnancy-related group and the non-pregnancy group is 2. 1 cm and 2.6cm respectively.There were 19 cases of multi-focal cancer ( 19.6% ) in the pregnancy-related group and 58 cases (9. 6% ) in the non-pregnant group, P ＜0.05. There were 23 patients (23.7%) of extrathyroid invasion in the pregnancy-related group and 65 patients ( 10.8% ) in the non-pregnant group, P ＜0.05. There were 67 cases (53.6%) and 35 cases (28%) of the central and lateral cervical lymph node metastasis in the pregnancy-related group respectively and 296 cases (42.8%) and 117 cases (16. 9% )in the non-pregnant group, P ＜0.05. There were 19 cases (15.2%) of extralymph invasion in the pregnancy-related group and 32 cases (4.6%) in the non-pregnant group, P ＜ 0.05. Conclusions The incidence of Extrathyroid invasion, multi-focal cancer, cervieal lymph node metastasis and extralymph invasion of the differentiated thyroid cancer is higher in pregnancy-related patients.Pregnancy may deteriorate the prognosis of thyroid cancer. For patients after the surgery of thyroid cancer, pregnancy may increase the risk of neck recurrence and metastasis. However, pregnancy does not affect the stage of thyroid cancer and the prognosis is still good.
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Elective neck irradiation is usually used as the modality of choice for the treatment of phase N 0 head and neck cancers. The increasing use of 3 dimensional conformal treatment planning has created an urgent need for new guidelines for the classification and delineation of the neck node areas. Surgical literature has provided us with valuable information in this field. The development of imaging technology has also offered us more detailed information. Several surgical and imaging methods have been proposed in this article, with the hope to give reference to most radiation oncologists. [
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Purpose:To investigate the type of surgery appropriate for substernal benign thyroid tumor. Methods:A study of 19 substernal benign thyroid tumors operated between 1990 and 1999 was made. Surgery via cervical collar incision were performed in all cases. Results:Among them 4 cases was adenoma, 16 cases goiter. There were no complications except for 1 case with recurrent laryngeal nerve paralysis. Conclusions:Surgery via cervical collar incision for substernal benign thyroid tumors is safe.