ABSTRACT
Background: Surgery is the mainstay in the management of thyroid cancer. Surgical outcomes need to be tempered against the excellent prognosis of the disease. Aims: This study aims to study the surgical outcomes including the 30-day morbidity and 5-year survival of thyroid cancer patients. Settings and Design: Retrospective analysis of a prospectively maintained surgical database in a tertiary cancer center in India. Materials and Methods: We analyzed 221 surgically treated patients in the year 2012. Statistical Analysis: Used IBM SPSS 24.0 (Armonk, NY) with p < 0.05. Results: The median age was 40 years with predominantly papillary thyroid carcinoma (55%). Localized disease in 47% of cases, locoregional disease in 42.5% and distant metastasis in 10.2% of cases at presentation was noted. Treatment naïve patients were 71% and revision surgeries were done in 29% patients. Extended thyroidectomy constituted 11% of the surgeries. Temporary hypocalcemia was seen in 30.8% of patients, 5% requiring intravenous calcium supplementation. Vocal cord palsy as per nerve at risk and chyle leak were seen in 4.5% and 3.1%, respectively. Aggressive histology, extended thyroidectomy, and inadvertent parathyroidectomy were significant factors associated with complications. Five year estimated overall survival with median follow-up of 50 months was 98%, and event-free survival was 84.8%. Advanced age, distant metastasis at presentation and aggressive histology connoted poor outcomes. Conclusion: Thyroid cancer, irrespective of the extent of disease, has good prognosis. Aggressive histology, the extent of thyroid surgery, distant metastasis and age are important factors, which should be factored in the algorithm of thyroid cancer management.
ABSTRACT
Retalhos do músculo esternocleidomastoideo têm sido descritos na literatura para reconstrução dos defeitos da cavidade oral e tratamento da síndrome de Frey. Apesar de largamente estudado, esses retalhos não são utilizados com frequência para reconstruções na região de cabeça e pescoço devido limitações como tamanho reduzido, camadas inseguras, contorno da deformidade no pescoço e questões de segurança oncológica. Relata-se uso de perfurador baseado em transposição de retalho para defeito na região da posterior do pescoço, seguido por excisão de sarcoma de partes moles. Trata-se de alternativa válida para procedimentos de reconstrução como retalhos regionais de pedículo ou transferência de tecido livre em um grupo apropriado de pacientes.
Sternocleidomastoid musculocutaneous flaps have been described in the literature for reconstruction of oral cavity defects and treatment of Frey's syndrome. Although widely studied, it is not used routinely in head and neck reconstruction due to limitations like small size, unreliable skin paddle, contour deformity in the neck and the question of oncologic safety. We report use of perforator based musculocutaneous transposition flap for defect over nape of the neck, followed by excision of a soft tissue sarcoma. This constitutes a valid alternative to other reconstructive procedures like pedicled regional flaps or free tissue transfer in a suitable group of patients.
Subject(s)
Humans , Male , Adult , History, 21st Century , Sarcoma , Surgical Flaps , Plastic Surgery Procedures , Diffusion of Innovation , Body Contouring , Neck , Neck Muscles , Neoplasms, Connective Tissue , Sarcoma/surgery , Sarcoma/pathology , Surgical Flaps/surgery , Plastic Surgery Procedures/methods , Body Contouring/adverse effects , Body Contouring/methods , Neck/abnormalities , Neck/surgery , Neck Muscles/surgery , Neoplasms, Connective Tissue/surgeryABSTRACT
Câncer em cabeça e pescoço é entidade muito comum nos países em desenvolvimento. Nos defeitos pe- quenos ou não complexos, podemos utilizar da várias opções para reconstrução, como retalhos locais ou pedículadosadistância,masquandonosdeparamoscom defeitos grandes ou complexos, microcirurgia torna-se necessária.
Introduction: head and neck cancer are very common entities of developing countries. In small or non complex defects we have a lot of options for reconstruction, like local or pedicle flaps, but when we consider big or complex defects microsurgery is necessary. Methods: in our casuistic, we have used radial forearm free flap for oral cavity, tongue and faryngeal defects, free anterolateral thigh flap with vastus lateralis muscle for maxilla defects and free fibula flap for mandible defects, between 20 patients. All flaps were done in the same institution and by the same surgical team. Results: the most common complications observed in microsurgical flaps like venous thrombosis and hematoma were not observed in this casuistic of 20 cases. Conclusion: microsurgical flaps for head and neck reconstruction represent an excellent alternative for big and complex defects, with low complication rates.