Appraisal of completion thyroidectomy for well differentiated thyroid carcinoma [WDTC]

Fifty patients with total lobectomy for WDTC were subjected to completion thyroidectomy [between 15 days to 4 years] following their initial procedure. Patients were categorized into two groups: Group I comprised 36 patients with no clinical evidence of any residual disease at the time of their completion procedure and Group II comprised 14 patients who at the time of their completion surgery had recurrent diseases either locoregional or metastatic. Completion thyroidectomy was shown to be a fairly safe procedure with a low incidence of complications [4% incidence of recurrent laryngeal nerve injury and 10% transient hypocalcemia]. When completion thyroidectomy is performed electively after complete lobectomy, residual subclinical disease will be discovered in 33% of the cases and the prognosis would be better

Pharyngo-Cutaneous fistula after total laryngectomy for carcinoma: a study of the predisposing factors and different lines of management

One hundred and fifty five patients with laryngeal cancer who underwent total laryngectomy at the NCI were evaluated as regards the incidence of pharyngocutaneous fistula, the factors predisposing to its occurrence and the various lines of management. Pharyngocutaneous fistula was encountered in 42.4% of cases. This rate was found to correlate significantly with the extent of mucosal resection and preoperative hemoglobin level. No correlation was found between fistula incidence and other factors such as age, site, nodal status, pathological grade, prior radiotherapy or preoperative tracheostomy. Among 155 patients, 4 had planned pharyngostomies for secondary reconstruction later on. In 136 patients who underwent simple closure, 82 achieved initial success [60.3%], while the initial success rate was [33.3%] in patients with primary flap reconstruction. 64 of the patients had failure after primary pharyngeal closure or reconstruction [42.4%], 7 had uncontrolled infection and died as a result of their fistulas, 15 other patients were lost to follow-up before healing. The remaining 42 patients had ultimate healing of their fistulas either conservatively or surgically, and resumed oral feeding. Secondary repair was necessary in 17 patients