Clinicopathological analysis of superior mediastinal lymph node metastases in medullary thyroid carcinoma / 中华肿瘤杂志

Objective: To investigate the clinicopathological characteristics of superior mediastinal lymph node metastases (sMLNM) in medullary thyroid carcinoma (MTC). Methods: This retrospective analysis enrolled the patients who were treated for sMLNM of MTC in our hospital from May 2012 to January 2021. All patients were suspected of sMLNM due to preoperative imaging. According to the pathological results, the patients were divided into two groups named sMLNM group and the negative superior-mediastinal-lymph-node group. We collected and analyzed the clinical features, pathological features, pre- and post-operative calcitonin (Ctn), and carcinoembryonic antigen (CEA) levels of the two groups. Logistic regression analysis was used to analyze risk factors, and receiver operation characteristic (ROC) curves were drawn to determine the optimal cut-off values of preoperative Ctn and preoperative CEA for predicting sMLNM. Results: Among the 94 patients, 69 cases were in the sMLNM group and 25 cases were in the non-SMLNM group. Preoperative Ctn level (P=0.003), preoperative CEA level (P=0.010), distant metastasis (P=0.022), extracapsular lymph node invasion (P=0.013), the number of central lymph node metastases (P=0.002) were related to sMLNM, but the multivariate analysis did not find any independent risk factors. The optimal threshold for predicting sMLNM by pre-operative Ctn is 1500 pg/ml and AUC is 0.759 (95% CI: 0.646, 0.872). The sensitivity, specificity, positive predictive value, and negative predictive value of diagnosis are 61.2%, 77.3%, 89.1%, 39.5%, respectively. In patients who underwent mediastinal lymph node dissection through transsternal approach, the metastatic possibility of different levels from high to low were level 2R (82.3%, 28/34), level 2L (58.8%, 20/34), level 4R (58.8%, 20/34), level 3 (23.5%, 8/34), level 4L (11.8%, 4/34). Postoperative complications occurred in 41 cases (43.6%), and there was no perioperative death in all cases. 14.8% (12/81) of the patients achieved biochemical complete response (Ctn≤12 pg/ml) one month after surgery, 5 of these patients were in sMLNM group. Conclusions: For patients who have highly suspicious sMLNM through imaging, combining with preoperative Ctn diagnosis can improve the accuracy of diagnosis, especially for patients with preoperative Ctn over 1 500 pg/ml. The superior mediastinal lymph node dissection for the primary sternotomy should include at least the superior mediastinal levels 2-4 to avoid residual lesions. The strategy of surgery needs to be cautiously performed. Although the probability of biochemical cure in sMLNM cases is low, nearly 40% of patients can still benefit from the operation at the biochemical level.

Treatment strategy of thyroid cancer with trachea,larynx, and major vessels involvement / 中国实用外科杂志

Surgical treatment of thyroid cancer with surrounding structures involved remains a challenge for physicians.Trachea and larynx are common affected organs,and complete resection can bring the greatest survival benefit.However,postoperative quality of life may be greatly affected.It is necessary to improve the quality of life of patients by stage Ⅰ or Ⅱ reconstruction. The case of papillary thyroid carcinoma invading the internal jugular vein or with internal jugular vein tumor thrombus can still be safely and completely removed.Some cases with carotid artery invasion could benefit from radical resection,in which case vascular reconstruction should be done simultaneously.Multidisciplinary treatment should be emphasized for the locally advanced cases. Postoperative radioactive iodine therapy,external beam radiotherapy,endocrine therapy should be considered to reduce local recurrence. For inoperable patients,participating a clinical trial or trying targeted therapy could be good choices. Patients with poor general condition may be given palliative care to alleviate the symptoms.

Nearby perforator flaps as alternative choices for anterolateral thigh flap when lacking useful perforator / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the proposal using nearby perforator flaps as alternative reconstructive choices for anterolateral thigh (ALT) flap when lacking useful perforator.</p><p><b>METHODS</b>From August 2010 to August 2012, 8 cases with head and neck cancer were found lacking reliable perforator during ALT flap elevation, a tensor fascia latae (TFL) flap or an anteromedial thigh (AMT) flap was used to complete the reconstruction.</p><p><b>RESULTS</b>All 8 alternative flaps were successfully harvested, other donor sites were not needed. Flap harvest time was 50-85 min. Of 5 TFL flaps, pedicle lengths were 6-10 cm, and the diameters of the arteries and veins were 2.5-3.0 mm and 2.5-3.5 mm respectively. Of 3 AMT flaps, pedicle lengths were 10-15 cm, the rectus femoris branch was used as pedicle in 1 flap, with artery and vein more than 1.0 mm in diameter, and the descending branch of the lateral circumflex femoral artery was used as pedicle in other 2 flaps, the diameters of the arteries were 3.5 and 3.0 mm respectively, the diameters of the veins were 3.5 mm. The donor sites were directly closed in 7 cases and skin graft was performed in another case. All the flaps were alive and no complication was found in the donor sites.</p><p><b>CONCLUSION</b>TFL or AMT flap is an good alternative to ALT flap lacking useful perforator.</p>

Primary squamous cell carcinoma of the thyroid: retrospective analysis of 28 cases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological features, treatment outcomes and prognosis of patients with squamous cell carcinoma of the thyroid (SCCT).</p><p><b>METHODS</b>Retrospective review of SCCT cases in our hospital from January 1999 to May 2012. Demographic data and clinical charts, including presenting symptoms, histologic grade of tumor, treatment, and outcome of 28 consecutive patients were obtained. Survival rates and prognostic factors were calculated with SPSS 13.0 software using the Kaplan-Meier method and multivariate Cox model survival analysis.</p><p><b>RESULTS</b>SCCT accounted for only 0.36% of all types of thyroid malignancy. There were 15 males and 13 females, and the median age was 63 years. The presenting symptoms were neck masses (26/28) and hoarse voice (18/28). The 28 SCCTs included 15 high grade tumors, eight intermediate grade tumors and five low grade tumors. According to the UICC 2002 staging criteria, 16 patients were stage IVa, and 12 were stage IVb. Of the 28 patients, 19 underwent surgery plus postoperative radiotherapy, seven underwent surgery alone, and two received radiotherapy alone. The rates of lymph node metastasis and distant metastasis were 60.7% and 25.0%, respectively. The 1-year, 2-year and 5-year overall survival (OS) rate were 50.4%, 25.8% and 19.3%, respectively, and the median overall survival time was 12.2 months. Kaplan-Meier univariate survival analyses indicated that the sizes of the tumors, esophageal invasions and treatment policies are prognostic factors, and multivariate Cox model survival analyses confirmed that the sizes of the tumors and treatment policies were independent factors for OS. Multivariate survival analyses confirmed that the sizes of the tumors and treatment policies were independent factors for OS.</p><p><b>CONCLUSIONS</b>SCCT is a rare malignant tumor with strong invasive ability, high malignancy and poor prognosis. Combined modality therapy was strongly recommended, and surgical resection plus postoperative radiotherapy may be the main treatment protocol for patients with SCCT.</p>

Clinical analysis of 27 cases of well differentiated carcinoma of the thyroid isthmus / 中华肿瘤杂志

<p><b>OBJECTIVE</b>Well differentiated thyroid carcinoma (WDTC) may be located in the isthmus. The guidelines now have not mentioned an appropriate procedure for WDTC in the isthmus. The aim of this study was to retrospectively analyze the outcomes in patients with WDTC in the isthmus treated at our institution.</p><p><b>METHODS</b>Twenty-seven patients with WDTC in the isthmus were managed by surgery in the Cancer Hospital of Chinese Academy of Medical Sciences from 1985-2006. Their demographic data, surgical procedures, pathological features, stages and outcomes were analyzed.</p><p><b>RESULTS</b>Five patients were men and 22 were women. The median age was 41 (range, 20-69) years. Nine patients received isthmusectomy, fourteen patients received extended isthmusectomy and four received isthmusectomy with unilateral lobectomy. There were no complications of recurrent laryngeal nerve palsy or hypocalcaemia. The median size of lesion was 1.0 cm(range, 0.5-4.0 cm). Sixteen patients had a pathologically T1a lesion (pT1a), seven patients were pT1b, two patients were pT2 and two pT3. Three patients had papillary carcinoma detected in perithyroid lymph nodes (pN1a). Among the 27 cases, 25 patients had a solitary malignant nodule confined to the isthmus, one had two malignant nodules confined to the isthmus and one had two malignant nodules located separately in the isthmus and right lobe. The patients were followed up with a median follow-up time of 85 months(range, 37-274 months). The 5-year recurrence-free survival was 95.2% and overall survival rate was 100%.</p><p><b>CONCLUSIONS</b>Our results suggest that isthmusectomy or extended isthmusectomy are feasible and efficient for the patients with WDTC located in the isthmus, and concurrent pretracheal lymph node dissection should be considered.</p>

Clinical outcomes of salvage surgery for nasopharyngeal carcinoma after irradiation failure / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study salvage surgery for persistent or recurrent nasopharyngeal carcinoma after irradiation failure.</p><p><b>METHODS</b>A total of 84 cases underwent salvage surgery for persistent or recurrent nasopharyngeal carcinoma after irradiation failure between 1993 and 2009 was reviewed. rTNM stage: rT1 34 cases, rT2 27 cases, rT3 12 cases and rT4 11 cases; rN0 70 cases, rN1 9 cases and rN2 5 cases; No with distance metastatic. The salvage surgeries were performed using maxillary swing approach (47 cases), transcervical-mandibulo-palatal approach (21 cases), palate nasopharyngectomy (6 cases), lateral rhinotomy (7 cases), and maxillectomy (3 cases).</p><p><b>RESULTS</b>Persistent or recurrent nasopharyngeal carcinoma after irradiation failure was resected completely in 57 patients (67.9%) and there were microscopic residual diseases in 27 patients (32.1%). The median follow-up was 27 months. Postoperative recurrence occurred in 35 cases. Thirty-six patients died of recurrence, metastasis and other diseases. The overall 5 year survival rate was 43.6%. Cox regression analysis indicated the complete resection for persistent or recurrent disease and no cervical metastasis were two independent factors affecting survival.</p><p><b>CONCLUSIONS</b>Salvage surgery for persistent or recurrent nasopharyngeal carcinoma after irradiation failure is an effective treatment.</p>

Lateral cervical approach for resection of cervical dumbbell-shape neurogenic tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To study the indication and character of the lateral-cervical approach for treating dumble-shape neurogenic tumors in cervical spine.</p><p><b>METHODS</b>Retrospectively review the clinical data of 14 dumble-shape neurogenic tumors in cervical spine, from October 2005 to October 2011. Among them 8 were males and 6 were females, range from 11 to 60 years old. The maximum tumor diameter range from 3.0 to 8.0 cm, with an average of 4.8 cm; the intraspinal tumor diameter range from 1.3 to 3.8 cm, with an average of 2.1 cm. According to Asazuma classification, 9 cases were type IIc, 2 cases were type IIIb, 2 cases were type IV, 1 case was type VI. Involving the neck segment C(1)-C(2) in 1 case, C(2)-C(3) in 1 case, C(3)-C(4) in 2 cases, C(4)-C(5) in 2 cases, C(5)-C(6) in 3 cases, C(6)-C(7) in 4 cases and C(2)-C(4) in 1 case. All cases performed surgery with general anethesia. The head and neck surgeon performed surgery with lateral cervical approach, in the space between the anterior and the medius scalenus, exposed the transverse process and the intervertebral foramen as the anatomy marker, resected the extraspinal tumor part. The neurosurgery expanded the intervertebral foramen, and resected the intraspinal tumor with microscope, and repaired the dura. Then head and neck surgeon closed the wounds.</p><p><b>RESULTS</b>Pathology proved 3 neurolimmoas and 11 Schwannomas, 12 cases received gross total resection, 2 cases received subtotal resection, the average blood loss during operation was 292 ml, the average operation time was 129 minutes, the average stay in hospital days was 7.1 days. The vertebral artery were exposed in 2 cases, and no vertebral artery injury occurred, there were 3 cases dissect the cervical nerve roots. No cerebrospinal fluid leakage, hematoma, newly branchial plexus injury, sympathic nerve injury or tracheal edema occurred. In 3 to 24 months, with an average of 13.5 months follow-up period, 2 cases with subtotal resection had no tumor progression, and 12 cases with gross total resection had no tumor recurrence.</p><p><b>CONCLUSIONS</b>Lateral-cervical approach is minimal invasive, easily to perform and recovery fine. It can be adopt for Asazuma type IIc, IIIb and IV tumors which not grow over the midline in spine and expand to deep layer of the deep cervical fascia out spine.</p>

Surgical management of parapharyngeal lymph node metastasis of thyroid carcinoma: a retrospective study of 25 patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Parapharyngeal lymph node (PPLN) metastasis from thyroid carcinoma is rare. We describe the clinical features, diagnosis, and surgical treatment of this condition.</p><p><b>METHODS</b>Twenty-five patients with PPLN metastasis from thyroid carcinoma were treated at our institution from January 1999 to December 2010, including 22 patients with papillary carcinoma, two with medullary carcinoma, and one with follicular carcinoma. Of these, 16 had a history of surgical treatment prior to PPLN metastasis. Of the nine patients without a history of surgical treatment, five had widespread cervical lymph node metastases and four had occult papillary thyroid carcinoma. PPLN metastasis was diagnosed by enhanced computed tomography in 22 cases.</p><p><b>RESULTS</b>Resection of metastases was performed via a transcervical approach in 23 patients and a transmandibular approach in two patients. After a median follow-up time of 31 months (range: 6 - 130 months), nine patients developed distant metastases, and six of these died of their disease. The 5-year survival rate was 63.8%.</p><p><b>CONCLUSIONS</b>PPLN metastasis from thyroid carcinoma may occur in patients: with previous neck dissection, with widespread metastases to cervical lymph nodes prior to initial treatment, and with occult thyroid carcinoma. Enhanced computed tomography is helpful for diagnosis in the first two presentations. Surgical resection remains the mainstay of treatment for this disease. PPLN metastasis has a tendency to be associated with distant metastases and a poor prognosis.</p>

Management of thyroglossal duct carcinoma: report of five cases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the clinical characteristic, diagnosis, surgical treatment and prognosis of thyroglossal duct carcinoma (TDCa).</p><p><b>METHODS</b>A total of 110 patients with thyroglossal duct remanat in our hospital between 1991 and 2011 was reviewed. Five patients of them were diagnosed with TDCa by pathological examination, including 4 cases of papillary carcinoma and 1 case of squamous cell carcinoma.</p><p><b>RESULTS</b>All five patients were men and the median age was 41 years (range from 17 - 73 years). Pulmonary metastasis was found preoperatively in one patient with papillary carcinoma. All five patients were managed by surgical treatment. Sistrunk operation was performed with resection of the tumor, thyroglossal remanat and partial hyoid bone in 2 patients, with resection of thyroid nodule in one patient, with total thyroidectomy and central neck dissection in one patient with pulmonary metastasis, with extensive resection of invading tissues in one patient with squamous TDCa. Two patients with papillary carcinoma underwent the treatment with TSH suppression postoperatively, of them one with pulmonary metastasis received radioactive iodine therapy simultaneously. The remaining three patients did not receive any further treatment. With follow-up of 14 - 45 months, local recurrence occurred in one patient with squamous TDCa after two months and caused death seven months after surgery, and the other four patients survived.</p><p><b>CONCLUSIONS</b>TDCa is a rare malignant tumor that is usually diagnosed after surgery. The Sistrunk operation may be adequate for low-risk cases.</p>

Functional reconstruction after total or near total glossectomy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the functional outcomes of patients who underwent total or near total glossectomy with pectoralis major myocutaneous flap (PMMF) or free flap (FF) reconstruction.</p><p><b>METHODS</b>Retrospective study of 38 consecutive patients undergoing total or near total glossectomy with PMMF or FF reconstruction. The outcomes of decannulation, feeding and speech function recovery were compared.</p><p><b>RESULTS</b>Near total glossectomy was performed in 33 patients and total glossectomy was performed in 5 patients. Twenty five patients underwent reconstruction with PMMF including 2 salvage reconstructions after free flaps failure. All PMMFs survived except one complete necrosis. The success rate of PMMF was 96.0% (24/25). Fifteen patients underwent reconstruction with FF. Two flaps developed complete necrosis and the success rate of FF was 86.7% (13/15). The difference in the rates between the two groups was not significant (P=0.545). In the PMMF and FF groups, the renewal of oral feeding were 65.2% (15/23) and 100% (13/13), P<0.05, and the tracheostomy decannulation were 52.2% (12/23) and 100% (12/12), P<0.05, respectively. Postoperative feeding function recovery was better in FF group than that in PMMF group (P=0.011). Single factor analysis showed that using FF and maintaining the continuity of the mandible were related to successful rate of renewal of oral feeding. Multivariate Logistic regression analysis showed that the continuity of the mandible was the only independent predictor for renewal of oral feeding. There was no significant difference in the postoperative speech functions between the two groups.</p><p><b>CONCLUSIONS</b>The continuity of the mandible is the major factor to restore the functional outcomes in feeding after total or near total glossectomy. Compared with PMMF, using FF is more beneficial to retain or rebuild the continuity of the mandible.</p>

Clinical analysis of surgical complications after preoperative concurrent chemoradiotherapy of pyriform sinus cancer / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To compare the surgery complications and laryngeal function sparing rate after preoperative concurrent chemoradiotherapy and preoperative radiotherapy of pyriform sinus cancer.</p><p><b>METHODS</b>Forty-six patients with squamous cell carcinoma of pyriform sinus from March 2002 to March 2009 were retrospectively analyzed. Concurrent chemotherapy with radiotherapy (CRT + S group) was conducted in twenty-three patients. Cisplatin (50 mg/weekly) was mostly applied. Twenty-three patients were treated with radiation only (RT + S group). Surgery was conducted after a break-time of 21 - 44 days (median, 31 d) and 17 - 40 days (median, 28 d), respectively.</p><p><b>RESULTS</b>The complication rate of CRT + S group and RT + S group were 30.4% and 39.1% respectively, no significant differences was found (χ(2) = 0.099, P < 0.05). The one-year laryngeal function sparing rate of the two groups were 52.2% and 17.4% respectively, with significant differences (χ(2) = 6.133, P < 0.05). The one-year local regional control rate and disease free survival rate for the CRT + S group were 89.9%, 71.1%, and for RT + S group were 56.3%, 47.1%, P level were 0.018 and 0.037, respectively. There was significant differences in one year local regional control rate and disease free survival rate between the two groups.</p><p><b>CONCLUSION</b>The addition of concurrent chemotherapy to preoperative radiotherapy in patients with pyriform sinus cancer does not increase the incidence of surgery complications. Chemotherapy improves the remission rate and appears to increase the laryngeal function sparing rate. Preoperative concurrent chemoradiotherapy can improve the local and regional control, and certainly, more investigations will be needed.</p>

Relationship between MAP3K5 and Epstein-Barr virus-encoded miR-BART22 expression in nasopharyngeal carcinoma / 南方医科大学学报

<p><b>OBJECTIVE</b>To detect the expression of MAP3K5 and miR-BART22 encoded by Epstein-Barr virus and explore their relationship in nasopharyngeal carcinomas (NPCs).</p><p><b>METHODS</b>Fifty-three archived specimens of NPCs and 30 nasopharyngitis specimens were collected for detecting the expression of EBERs and miR-BART22 by in situ hybridization, and the expression of MAP3K5 was detected using immunohistochemistry. Ten fresh NPC and 10 fresh nasopharyngitis specimens were also obtained for determining the protein expression of MAP3K5 by Western blotting.</p><p><b>RESULTS</b>EBERs were positive in all the 53 NPC specimens, and miR-BART22 was positive in 49 specimens; all the 30 nasopharyngitis specimens were negative for EBER or miR-BART22. In the 53 NPC tissues, 50 were negative for MAP3K5 expression in the cancer areas but positive in the adjacent mucosal areas, with the other 3 specimens showing a weak positivity (+). In the 30 nasopharyngitis specimens, 25 showed strong MAP3K5 positivity, 3 showed weak positivity and 2 were negative for MAP3K5 (P<0.001). Western blotting showed that the expression of MAP3K5 protein was significantly higher in nasopharyngitis than in NPC tissues (P=0.029). The expression of MAP3K5 and miR-BART22 was inversely correlated (P<0.001).</p><p><b>CONCLUSION</b>Compared with the adjacent mucosal tissues, NPC tissues have a lower expression of MAP3K5 but a higher expression of miR-BART22. The expression of MAP3K5 and miR-BART22 is inversely correlated, suggesting the possibility of MAP3K5 to serve as target gene of EBV miR-BART22. miR-BART22 may inhibit the expression of MAP3K5, thus reducing the protein phosphorylation of MAPK pathway downstream genes, inhibiting NPC cell apoptosis, preventing their differentiation and promoting their escape from immune surveillance.</p>

Fatal hemorrhage following surgery for head and neck carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the surgical management of fatal hemorrhage following head and neck surgery for cancer.</p><p><b>METHODS</b>The clinical data of 32 cases of fatal hemorrhage following head and neck surgery from 1976 to 2008 in our department were analyzed retrospectively.</p><p><b>RESULTS</b>Hemorrhage was caused by carotid blowout in 20 cases. The carotid ligation was performed in 13 cases, only 6 cases got long-term survival. In 12 cases, hemorrhage was caused by tracheo-innominate artery fistula, only 2 cases received surgical management, and no long-term survivors.</p><p><b>CONCLUSION</b>Fatal hemorrhage following head and neck surgery is an uncommon but frequently fatal complication, and the successful management of it depends on early diagnosis and correct treatment.</p>

Surgical treatment of thyroid carcinoma with the upper mediastinal metastasis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the clinical characteristics and management of thyroid cancer with the upper mediastinal metastasis.</p><p><b>METHODS</b>A retrospective study was performed to analysis the clinical characteristics, treatment and prognosis of 122 cases who underwent mediastinal dissection for thyroid cancer invasion in Cancer Hospital of Chinese Academy of Medical Science from Jan. 1985 to Oct. 2004.</p><p><b>RESULTS</b>According to postoperative pathological diagnosis, upper mediastinal(2R/2L) were the most common areas invaded, 98.4%. The incidence rate of lower mediastinal invasion was 20.5%, which often occurred in the area of lower paratracheal (4R/4L). The complication rate of the sternotomy group (38.2%)was higher than the other (28.4%), but complications associated with mediastinal operation were rare, including pleural effusion (3 cases), mediastinal infection (1 case) and superior vena cava rupture (1 case), which were all cured. After a median follow-up of 60 months (range from 12 to 249 months), 9 patients were lost in the follow-up, the follow-up rate was 92.6%. The anticipate 5-year survival rate of differentiated thyroid carcinoma and medullary carcinoma in the sternotomy group from Kaplan-Meier curve were 90.9%, 87.1% while the other group 85.4%, 92.3% (P > 0.05). Three-year and 5-year mediastinal recurrence rate of sternotomy group were 3.8%, 12.2%, while transcervical operation group 7.9%, 14.2%.</p><p><b>CONCLUSIONS</b>It is noticed that there is a big percentage of patients with lower mediastinal invasion as well as upper area lesions. Radical operation is needed via sternotomy for these patients. For those who have many lymph nodes or the condition that lymph nodes adhere to the vessels , sternotomy also should be considered.</p>

Clinical analysis of dermatofibrosarcoma protuberans in head and neck / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the prognosis of dermatofibrosarcoma protuberans (DFSP) in head and neck after deferent treatment.</p><p><b>METHODS</b>The clinical data of 28 cases of DFSP in head and neck from 1982 to 2005 were analyzed retrospectively. Eleven cases were treated with wide excision, and 17 with limited excision. Twenty four cases had surgical resection alone (S), and 4 preoperative or postoperative radiotherapy (S + R) of 40-65 Gy. Eighteen cases received immediate reconstruction.</p><p><b>RESULTS</b>The overall recurrence rate was 21.4% (6/28), the recurrence rate of wide excision group was 0 (0/11), compared with 35.3% (6/17) in the limited excision group (P = 0.033); the recurrence rate of S + R group was 0 (0/4), compared with 25.0% (6/24) in S group, but there was no significant deference (P = 0.357). The overall 5-year survival rate was 88.9%. The 5-year recurrence free survival rate was 100% in wide excision group, compared with 59.6% in the limited excision group (chi2 = 3.933, P = 0.047).</p><p><b>CONCLUSIONS</b>Wide excision could significantly reduce the recurrence rate of DFSP in head and neck, when the adequate margin couldn't be achieved or the excision margin was positive, adjuvant radiotherapy might be helpful. The immediate reconstruction was necessary when the defect was large.</p>

Reconstruction with free jejunal interposition for defect after tumor resection of hypopharyngeal and cervical esophageal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the use of free jejunal flap in reconstruction for circumferential defect after tumor resection of hypopharyngeal and cervical esophageal cancer.</p><p><b>METHODS</b>Retrospective review of 51 patients who underwent circumferential pharyngoesophageal reconstruction with free jejunal flap after tumor ablation.</p><p><b>RESULTS</b>In 51 patients, 5 had flap failure and the flap success rate was 90% (46/51). Forty-five patients had oral intake after operation excluding one who had anastomosis stenosis and 5 who had flap failure. The 1-year and 3-year survival rate was 62% and 48% respectively. Positive surgical marginal status and external invasion including thyroid gland, carotid artery, skin and pre-vertebral area were indicators for bad prognosis. Except 5 patients who had flap failure, one of which died from mediastinal infection, no other severe complications occurred.</p><p><b>CONCLUSIONS</b>Patients reconstructed with free jejunal flap after resection of hypopharyngeal and cervical esophageal cancer had low mortality and few complications. Those without positive surgical margin and external invasion including thyroid gland, carotid artery, skin and pre-vertebral area had higher survival rate. Most of them had good quality of life. The choice of free jejunal flap for reconstruction of hypopharyngoesophageal defect was appropriate in selected patients who had guarantee of negative surgical margin and no external invasion.</p>

Prospective cohort study on prevention of Frey syndrome in parotid surgery / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the prevention of Frey syndrome after parotidectomy.</p><p><b>METHODS</b>A prospective cohort study of 100 patients with parotid cancer who received parotid surgery was underwent in our hospital from 2001 to 2004. These patients were assigned to two groups, study group (50 cases) and control group (50 cases). The patients in the study group received parotidectomy and intraoperative placement of collagen pieces within the parotid bed, between the skin flap and the facial nerve. The patients in the control group received a conventional parotidectomy and no collagen pieces was implanted. All of the patients were followed-up and were evaluated for Frey syndrome with identical questionnaires.</p><p><b>RESULTS</b>Compared with control group, the incidence rate of Frey syndrome was significantly decreased in the study group (20% vs 60%, chi(2) = 15.04, P < 0.001). Postoperative incidence of facial contour apparent deformity was 80% (40/50) in control group and 44% (22/50) in study group (chi(2) = 12.26, P < 0.001).</p><p><b>CONCLUSIONS</b>Use of collagen pieces as an interposition fill barrier improves parotidectomy outcome by reducing the incidence of Frey syndrome, and it improves cosmetic results concurrently.</p>