Clinical practice of repair of large tracheal defects with local tension free flaps / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate a simple and practical method for the repair of large tracheal defects. @*Methods@#From April 2015 to October 2017, 10 patients with large tracheal wall defects after thyroid carcinoma underwent two phase repair with cervical tension free flap with modified design. In the longitudinal direction of the leakage, design two pieces of random flap outside the top angle of 45°, respectively, and the side turn double flip flap to repair the leak, outward and upward forming tension, avoid collapse after healing. @*Results@#Large tracheal wall defects in 10 cases were successfully repaired, and normal respiration and language functions were recovered quickly.With following-up of 6-30 months(the medran was 12 months), the airway kept normal ventilation, no recurrence, and 1 patient with pulmonary metastasis had a stable condition. @*Conclusion@#The modified tension free flap can be used for the repair of large defects of trachea with a good efficacy.

Long-term Outcomes of cN0 Papillary Thyroid Carcinoma without Elective Central Compartment Neck Dissection / 中国医学科学院学报

Objective To determine the long-term outcomes of cN0 papillary thyroid carcinoma without elective central compartment neck dissection. Methods The clinical data of 180 patients with clinically lymph node negative papillary thyroid carcinoma who were treated in our center between 2000 and 2005 were retrospectively analyzed. All of these patients did not receive elective central compartment neck dissection. Clinicopathological characteristics including gender,age,surgical range,pathologic type,tumor size,and extrathyroidal extension(ETE)or not were collected. Results After a median follow-up period of 90 months,only one patient died of stroke without tumor. Sixteen patients had tumor recurrence:seven patients had a recurrent disease in residual thyroid tissue,two in the thyroid bed,six in central compartment,eight in lateral cervical compartment,and one in lung. The 10-year overall survival,disease-specific survival,and recurrence-free survival was 99.4%,100%,and 87.9%,respectively. The 10-year accumulative lymph node recurrence rate in central compartment and lateral compartment was 7.8% and 7.0%,respectively. ETE was an independent risk factor for central compartment lymph node recurrence. Male gender(P=0.010)and ETE(P=0.028)were independent risk factors for lateral compartment lymph node recurrence. Conclusions The prognosis of patients with cN0 papillary thyroid carcinoma without elective central compartment neck dissection is good after ten years of follow-up. Male gender and ETE are independent risk factors for lateral compartment lymph node recurrence.

Evaluation of radionuclide therapy for the residue after surgery in papillary thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To assess the efficacy of radioactive iodine (RAI) for the treatment of residual papillary thyroid cancer (PTC) after surgery.</p><p><b>METHODS</b>A total of 20 patients diagnosed with PTC and underwent 2-6 courses of RAI therapy for residual PTC after surgery in other hospitals were included our study. Of these, 13 were in stage I, 3 in stage III and 4 in stage IV. All the cases were operated again due to the presence of suspicious residual tumors indicated by CT. Excision of thyroid tumor residue was performed in 5 cases and neck dissection in 15 cases (20 sides). The suspicious thyroid or neck residual tumors were examined pathologically after surgery. Response Evaluation Criteria in Solid Tumors (RECIST) was used to evaluate the efficacy of surgery treatment on residual tumor. T-test was used to identify variables associated to RAI and to calculate the propensity score to receive RAI after surgery.</p><p><b>RESULTS</b>The patients aged 22-58 years, with a median age of 40 years. The mean times of surgeries received before RAI was 1.5 and the mean dose of applied RAI was 318 mCi (210-660 mCi). No significant difference in tumor size between pre-RAI and post-RAI was found (t = 1.177, P > 0.05). With postoperative pathological examination, the suspicious thyroid or neck residual tumors were confirmed as PTC or the cervical lymph metastasis of PTC.</p><p><b>CONCLUSIONS</b>For the residue or metastasis of PTC after operation, reoperation should be a priority, while RAI therapy has no obvious therapeutic effect and it should be limited to selected cases such as those with distant metastasis or unsuitable for operation but with iodine uptake function, or taken as an adjuvant treatment after radical resection of cervical lesions.</p>

Analysis of the patterns of cervical lymph node recurrence in patients with cN0 papillary thyroid carcinoma after central neck lymph node dissection / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To retrospectively analyze the long-term results of prophylactic central lymph node dissection in cN0 papillary thyroid carcinoma (PTC), and investigate the treatment method of the cervical lymph nodes for cN0 PTC.</p><p><b>METHODS</b>One hundred and thirty-six patients with cN0 PTC were treated by surgery at the Cancer Hospital of Chinese Academy of Medical Sciences from 2000 to 2006. Their clinicopathological characteristics, surgical procedures and survival outcomes were collected and analyzed.</p><p><b>RESULTS</b>The occult lymph node metastasis rate in central compartment was 61.0%. The average number of positive lymph nodes was 2.47 (1-13), in which 54 patients had 1-2 and 29 patients had ≥ 3 positive lymph nodes. Multiple logistic regression analysis showed that age less than 45 (P=0.001, OR 3.571, 95% CI 1.681-7.587)and extracapsular spread (ECS) (P=0.015, OR 2.99, 95% CI 1.241-7.202)were independent risk factors for lymph node metastasis in the central compartment. The ten-year cumulative overall survival rate was 98.3% and cumulative lateral neck metastasis rate was 25.2%. Multivariate analysis with Cox regression model showed that ECS (P=0.001, OR 5.211, 95% CI1.884-14.411) and positive lymph nodes in the central compartment ≥ 3 (P=0.009, OR 4.005, 95% CI 1.419-11.307) were independent risk factors for lymph node recurrence in the lateral neck region. The distribution of recurrent lymph nodes: level IV (82.4%), level III (64.7%), level II (29.4%) and level V (11.8%).</p><p><b>CONCLUSIONS</b>Routine central lymph node dissection, at least unilateral, should be conducted for cN0 papillary thyroid carcinoma. Attention should be paid to the treatment of lateral neck region in patients with cN0 papillary thyroid carcinoma. Selective neck dissection is suggested for cN0 PTC with ECS or positive central lymph nodes ≥ 3, or both. The range of dissection should include level III and IV at least.</p>

Analysis of the effectiveness of radiotherapy in postoperative residual tumors in patients with thyroid papillary carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The aim of this study was to assess the impact of radiotherapy on patients with postoperative residual or recurrent papillary thyroid cancer (PTC).</p><p><b>METHODS</b>We retrospectively reviewed the medical records of 34 patients with PTC, who underwent surgery and radiotherapy in other hospitals, and treated at the Department of Head and Neck Surgery at Cancer Institute & Hospital CAMS from January 2011 to January 2014. Among the 34 cases, 22 were in stage I, 5 in stage II and 7 in stage IVa. The 34 patients received 1.5 times of surgery before radiotherapy in average. All the cases received radiotherapy (mean, 56 Gy; range, 50-70 Gy). The patients were re-operated in our hospital, and the specimens were examined by pathology. The pre- and post-radiotherapy images (CT and B-ultrasound) were compared, and the changes of tumor volume were examined. The objective effect of treatment on the tumor residual focus was evaluated using RECIST, and analyzed by t-test (SPSS 17.0).</p><p><b>RESULTS</b>All the re-resected lesions after radiotherapy were proved by pathology to be papillary thyroid cancer (PTC) or metastatic PTC in cervical lymph nodes. Among the 34 patients, 22 cases showed mild or moderate cell degeneration and the other 12 cases showed no obvious degeneration. The largest tumor diameter was 27.18 mm before radiotherapy and 27.76 mm after radiotherapy, with a non-significant difference between them (t=-1.618, P>0.05). Among the 34 patients, only 3 patients received reoperation, all other 31 cases had complete resection, and no severe complications were observed except recurrent laryngeal nerve injury in one case.</p><p><b>CONCLUSIONS</b>Radiotherapy has few therapeutic benefit to PTC patients after surgery with residual tumor or local recurrence. It should be used in the PTC patients, in which the tumor invasion involves important organ tissues and is difficult for a single operation to achieve safe resection margin, or in patients who can't bear a surgery because of severe coronary heart disease or others.</p>

Treatment and prognosis of the carcinoma arising from nasal and sinonasal inverted papilloma: report of 62 cases and systematic review / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the factors affecting prognosis of the carcinoma arising from nasal and sinonasal inverted papilloma.</p><p><b>METHODS</b>The clinicopathological data of sixty-two patients treated in our hospital from January 1974 to February 2012 were retrospectively analyzed. Of the 62 cases, 10 were at stage I or II, 24 at stage III, and 28 at stage IV. Twenty-six patients were treated with surgery alone, and 36 with surgery combined with radiation therapy. Kaplan-Meier method and log-rank test were used for the survival analysis.</p><p><b>RESULTS</b>The overall 5-years survival rate was 39.6%. The 5-years survival rate was 67.5% in the stage I or II patients,51.3% in the stage III patients, and 18.3% in the stage IV patients (P<0.05). The 5-years survival rate was 65.7% in patients who had no surgical history, and 29.9% in patients who had surgery (P<0.05). The 5-year survival rate was 17.6% in the group who relapsed after the treatment, and 49.6% in the non-relapsed patients (P<0.05). The 5-year survival rate was 23.4% in the patients who had involvement of cranial base and (or) orbit, and 47.6% in the patients whose cranial base and (or) orbit were clean (P<0.05). Of the patients at the same stage (III-IV), the 5-year survival rate of patients treated with surgery alone was 32.4%, and those treated with combination therapy was 36.2%(P=0.89). The univariate analysis showed that clinical stage, surgical history before malignization, involvement of the cranial base and (or) orbit organs, and post-operative relapse are significantly correlated to prognosis of the patients (P<0.05 for all). Multivariate analysis showed that age, clinical stage, and previous history of surgery were independent factors affecting the prognosis of the patients. Distant metastasis was the major cause of death, mostly lung metastases.</p><p><b>CONCLUSIONS</b>Age, clinical stage and surgical history are the main factors affecting the prognosis of the patients. The history of recurrence and involvement of cranial base or orbit also play an important role for the prognosis. Distant metastasis is the main cause of death in the patients with carcinoma arising from nasal and sinonasal inverted papilloma.</p>

Cervical lymph node metastasis in medullary thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the patterns of cervical lymph node metastasis of medullary thyroid carcinoma.</p><p><b>METHODS</b>Ninety-one patients with medullary thyroid carcinoma first treated between January 1999 and October 2014 were analyzed retrospectively. Of 91 patients, 39 cases presented with clinical negative node (cN0) and 52 cases with clinical positive node (cN+). Central compartment dissection was performed in all cases. Lateral neck dissection was performed in 52 cN+ cases (71 sides). All neck dissection specimens were obtained and analyzed for lymph node (LN) involvement with respect to neck levels. The distribution of LN with metastasis was studied in cN+ patients and the following factors were used to study the predictive value of central compartment LN metastasis: sex, age, family history, tumor size, bilateral tumor, multifocality of the tumor, extracapsular spread, and remote metastasis. Univariate analysis with the χ(2) test was used to analyze the statistical correlation between central compartment LN metastasis and other clinical factors. Multiple logistic regression analysis was used to identify the factors related to central compartment metastasis.</p><p><b>RESULTS</b>Neck and bilateral neck metastasis rates were 73.6%, 19.8% respectively. Metastasis rates in central compartment and superior mediastinal region were 68.1% and 27.5% respectively. The central compartment metastasis rate was 33.3% in cN0 patients and 94.2% in cN+ patients. The superior mediastinal metastasis rate was 2.6% in cN0 patients and 46.2% in cN+ patients. Extracapsular spread was an independent predictive factor for central compartment metastasis (χ(2)=15.592, P=0.000, OR=12.876). The incidences of LN metastases at level II, III, IV, V were 62.9%,84.5%,83.1%,50.0% in cN+ patient, respectively. Multi-sites were involved. The possibility of lateral neck metastasis was higher when preoperative value of calcitonin was higher than 300 ng/L (66.7% vs 28.6%, χ(2)=5.771, P=0.016).</p><p><b>CONCLUSIONS</b>Cervical lymph node metastasis of medullary thyroid carcinoma is higher. Central compartment dissection is necessary in cN0 patients with extracapsular spread. Neck dissection from level II to level VII was necessary in cN+ patients. Preoperative value of calcitonin maybe can predict the lateral neck metastasis incidence.</p>

Reconstruction of defect after resection of hypopharyngeal and cervical esophageal cancer by multiple tissue flaps / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore a new method for the reconstruction of defect after resection of hypopharyngeal and cervical esophageal cancer using pulled-up stomach combined with free jejunal flap or lanryngotracheal flap if pulled-up stomach can not reach the level of oral pharynx for ananstamosis.</p><p><b>METHODS</b>From June 2010 to June 2014, 56 cases of hypopharyngeal or cervical esophageal cancer were treated with pharyngogastric anastamosis, in 5 cases of them, because the length of pulled-up stomach was limited and could not reach oral pharynx, free jejunal flap was used in 2 cases with laryngeal invasion and laryngotracheal flap was used in 3 cases without laryngeal invasion to reconstruct the defect between oral pharynx and stomach.</p><p><b>RESULTS</b>Pharyngeal fistula occurred in 1 case with laryngotracheal flap reconstruction, but healed after 2 weeks of wound dressing. Other 4 cases had oral liquid diet two weeks after surgery and did not occur any complications such as infection or pharyngeal fistula. Follow-up showed 1 case died from mediastinal and lung metastases after 3 years, 1 case had cervical lymph recurrence after 2 years and still survived, and other 3 cases were tumor free survival for 28, 37, and 56 months respectively.</p><p><b>CONCLUSIONS</b>The defect after resection of hypopharyngeal and esophageal cancer can be reconstructed with pulled-up stomach combined with free jejunal flap or lanryngotracheal flap if pulled-up stomach can not reach the level of oral pharynx for ananstamosis.</p>

Application of scapula osteomyocutaneous flap in the repair of maxillary defect / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Preliminary study on free scapula osteomyocutaneous flap to repair maxillary defect.</p><p><b>METHODS</b>Central maxillofacial soft and hard tissue defect after nasal sinus or oral tumor surgery was repaired with free scapual osteomyocutaneous flap in 4 patients to reconstruct their maxillofacial functions. The primary tumors included an ameloblastoma, a recurrent low-grade mucous epidermoid carcinoma a jaw sarcoma and a squamous cell carcinoma.</p><p><b>RESULTS</b>All the 4 cases had good wound healing within 2 weeks after surgery, with no complications, could take in semifluid food after 3 weeks, and had clear language communication after 1 month. Three cases wore denture after 2 months and recovered maxillofacial contour and partial chewing function, and had no tumor recurrences with the follow-up of 37, 25 and 10 months respectively. One case of maxilla sarcomas had recurrence with invasion of parapharyngeal space and skull base and pulmonary metastasis 9 months after surgery, who gave up further treatment and died 1 year later. No obvious dysfunction occurred in shoulder and back donation sites and well blood supply in transplanted bones were showed with CT and bone scan.</p><p><b>CONCLUSIONS</b>Scapula osteomyocutaneous flap has some advantages including reliable blood supply, hidden incision and little affect on the donation site, and it can apply with multiple tissues including bone, muscle, and skin for repair. This flap also has good shape adaptability and availability. So scapula osteomyocutaneous flap is a satisfactory method for the repair of facial maxillary complex defects. But some limitations exist in the flap, by which less amount of bone can be applied and more operation time is required due to the changes of patient's body position during surgery.</p>

Preliminary study of patterns of level IIb lymph node metastasis in papillary thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the factors related to level IIb lymph node(LN) metastasis in papillary thyroid carcinoma (PTC). Method The medical records of 63 PTC patients were reviewed. The patients underwent neck dissection (ND) between January 2011 and December 2012, who were determined with pathologically lateral cervical LN metastasis. A total of 67 ND specimens were obtained and analyzed for LN involvement with respect to neck levels. The relation of level IIb LN metastasis with clinical factors, including age and sex of patients, tumor size, location, multifocality, extracapsular spread (ECS) and stage of primary PTC, coexistence of lymphocytic thyroiditis, distribution of metastasis LN in different levels, fusion and extracapsular invasion of LN were analyzed with univariate analysis and χ(2) test. SPSS 14.0 software was used to analyze the data.</p><p><b>RESULTS</b>Of 63 patients, 41 patients revealed thyroid tumor maximum diameter more than 1 centimeter, 26 patients with tumor located in the upper 1/3 thyroid lobe, 39 patients with multiplicity of thyroid tumor and 54 patients with ECS, 54 patients with pathological T3/T4a stage, 15 patients with coexisting lymphocytic thyroiditis. Among the 67 ND specimens, 12 specimens (17.9%) showed level IIb LN metastasis and the incidences of LN metastasis at level IIa, III, IV, V, VI, IIa+III, III+IV, and IIa+III+IV were 56.7%, 86.6%, 68.7%, 22.4%, 86.6%, 52.2%, 55.2%, 37.3%, respectively. Of the 38 ND specimens with level IIa LN metastases, 10 were positive in level IIb(26.3%). But of 29 ND specimens without level IIa LN metastases, only 2 were positive in level IIb. A univariate analysis revealed that level IIa LN metastasis was a significant predictive factor for level IIb LN metastasis (χ(2) = 4.219, P = 0.040).</p><p><b>CONCLUSION</b>The incidence of LN metastasis to level IIb is low in PTC, which is less when level IIa is not involved.</p>

Metastatic carcinoma of the thyroid gland: a report of 35 cases / 中华普通外科杂志

Objective To study the clinical characteristics, diagnosis, treatment and prognosis of cancer metastasis to the thyroid gland. Methods A restropective review was performed on 35 patients with cancer metastasis to the thyroid gland in our hospital from 1958 to 2010. Diagnosis was confirmed by fineneedle aspiration cytology or histopathology in all cases. Results Primary tumor origin was identified in all but three cases. The lung was the most common primary tumor site( n = 16), followed by esophagus( n =9),breast ( n = 2), kidney ( n = 2), hypopharynx ( n= 1 ), nasopharynx ( n = 1 ) and soft palate ( n = 1 ). Thyroid metastasis was found before the diagnosis of the primary tumor was established in 12 cases; in the other 23 cases, the time lapse from diagnosis of the primary tumor to metastasis to the thyroid gland ranged from 0- 168 months, median 24 months. In 6 patients, this interval was more than 36 months. Fine-needle aspiration cytology ( FNAC ) confirmed metastatic malignancy in 7 patients, histology in 24, combined application confirmed the diagnosis in 4. After the metastasis to the thyroid gland was established, the median survival time for the entire group was 11.5 months, the 1-, 3- and 5-year survival rate was 43.8%,27. 8% and 11.9%, respectively. 28 patients were treated surgically, and 7 received nonsurgical therapy.The overall survival rate in the surgical group was higher than that in the nonsurgical group (P ＜0. 01 ). In those patients with metastatic cervical lymph nodes, median survival time did not vary from patients undergoing thyroidectomy with neck dissection to those undergoing thyroidectomy alone (P ＞ 0. 05 ).Conclusions Metastasis of carcinoma to the thyroid gland has an occult occurrence, thyroid metastases can be detected conclusively with FNAC. Metastasis to the thyroid gland implies advanced malignant tumors,often with poor prognosis.

Evaluation for submental island flap / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the clinical effect of submental island flap.</p><p><b>METHODS</b>The influence of head and neck radiotherapy and neck lymph node metastasis on the flap was analysed. The clinical effect in the near future and longterm of submental island flap for defects repair was evaluated.</p><p><b>RESULTS</b>Thirty-eight submental island flap were applied for reconstruction of head and neck defects following cancer ablation between July of 1997 to December of 1999. 16 of these had preoperative radiotherapy at both donor site and receive site, and neck dissections with resection of primary lesions were simultaneously performed in 18 patients. The success rate was 89.5% (34 of 38). All repaired cases had well matched skin with facial surface and excellent texture for intraoral function.</p><p><b>CONCLUSIONS</b>Routine preoperative radiation does do not influence the success and healing of the flap. For tumor complete resection, appropriate cases should be chosen. We believe this flap is worthwhile in addition to the existing armamentarium of reconstruction options both facially and intraorally.</p>

Multidisciplinary cooperation in surgical treatment of complex head and neck tumor / 中华外科杂志

<p><b>OBJECTIVE</b>To study the multidisciplinary cooperation in surgical treatment of complex head and neck tumors.</p><p><b>METHODS</b>The data from 22 patients with head and neck tumors who had been given neurosurgery, orthopaedic surgery, plastic and otological surgery were reviewed from April 1995 to June 2000.</p><p><b>RESULTS</b>Eight of 14 cases of benign tumors had been resected radical; 5 of 8 malignant cases had been moval of macroscopic tumor and 3 received operation for symptom improvement. No surgical death and serious complications were observed. The recurrence rate benign tumors was 21.4% (3/14), all of which were operated on at other hospitals. Follow-up for a year showed that in 8 cases of malignant tumors, 3 were tumor free, 2 survived with tumor, and 3 died.</p><p><b>CONCLUSIONS</b>To obtain good outcome in treatment for patients with complex tumors of head and neck, cooperative efforts between multidisciplinary surgery are necessary.</p>