Key points and major challenges in the surgical management of recurrent of laryngeal cancer / 中华耳鼻咽喉头颈外科杂志

A systematic review of principles and strategies in surgical management of recurrent of laryngeal cancer is carried out. This article focuses on the roles of salvage and palliative operations in managing recurrent of laryngeal cancer, including the contents, methods and strategies of surgeries and aims to provide guidance for physicians in making treatment decisions and choosing proper surgical procedures, and thus to improve the outcome and prognosis of recurrent laryngeal cancer.

A clinical experience of endoscopic treatment for benign and malignant tumors of skull base / 天津医药

Objective To summarize the surgical skills and experience of skull base surgery by endoscopic treatment. Methods A total of 8 cases with benign and malignant tumors were treated in our hospital from August 2014 to December 2016, including orbital region, sellar region, clivus, pterygopalatine fossa and infratemporal fossa. The endoscopic endonasal surgery involved optic nerve decompression, internal carotid artery, treatment of middle skull base and clivus dura tumors, opening of pterygopalatine fossa and infratemporal fossa. The anti infection and anti inflammation treatment of the dura and the internal carotid artery and the treatment of the complications such as diplopia, vision decrease, and the adjustment of pituitary hormones were given to patients after operation. Results The visual of a patient with fungal sinusitis recovered from no light perception to "finger/1 m" at one week after surgery. One of the patients with pituitary tumor underwent unilateral eyeball abduction limitation. The symptoms disappeared after one week treatment. Insipidus occurred in 1 patient with invasive pituitary adenoma, after symptomatic treatment for half a month, urine volume and specific gravity tend to normal. Two patients with adenoid cystic carcinoma underwent enhanced MRI examination at 10 days, 3 months and 1 year after operation, both achieved total resection and no local recurrence. The patient with nasopharyngeal carcinoma reached total resection after operation, and showed no local recurrence after six-month follow-up. All the 8 patients achieved complete resection in one stage, without any serious complication after operation. Conclusion Endoscopic endonasal surgery is an important method for the treatment of tumour in anterior skull base, which needs extensive surgical experience and cooperation with other clinical departments.

Is There Any Benefit of Drain Placement on Postoperative Complications in Patients Undergoing the Sistrunk Procedure?

Introduction Same-day, outpatient Sistrunk procedure is commonly performed to manage thyroglossal duct cyst anomalies and may lead to postoperative complications. Surgical drains are placed to prevent complications, but recent observations show no advantage and rather increased health care costs and patient discomfort. Objective The study evaluated if drain placement in the Sistrunk procedure offers any benefit on postoperative complications. Methods A retrospective analysis of patient records having undergone same-day, outpatient Sistrunk procedure from 2004 to 2014 was done. Of 58 (38 male and 20 female) patients included, 38 did not have drains placed and the remaining 20 had drains placed. Mean and median age of patients was 18.1 and 13.5 years, respectively. Postoperative complications of patients with drains versus those without drains were statistically analyzed. Results Overall, about 10% of patients had hematoma/seroma (H-S), with 6.9% of patients needing aspiration for H-S; 3.4% had wound infections; and 1.7% had pus formation. No statistically significant differences in Sistrunk-related complications between patient groups (with drain or without drain) were seen using Fisher exact (two-sided) test: H-S (p = 0.08); need for aspiration (p = 0.29); wound infection (p > 0.05); and pus formation (p = 0.35). Chi-square test also did not show any significant difference in the groups in terms of number of follow-ups. Conclusion Surgical placement of a drain in the Sistrunk procedure does not seem to offer any advantage in terms of reducing common postoperative complications. Sameday Sistrunk procedure without any drain placement may be a safer alternative without necessitating hospitalization. More studies with larger sample size are needed for further substantiation.(AU)