Prognostic value of the age-adjusted Charlson comorbidity index in patients over 60 years old with laryngeal squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective: To evaluate the value of the age-adjusted Charlson comorbidity Index (ACCI) in predicting the prognosis and guiding the clinical treatment of laryngeal squamous cell carcinoma (LSCC) in patients over 60 years old. Methods: Retrospective analysis of 249 cases of LSCC in Shanxi Provincial Cancer Hospital and First Hospital of Shanxi Medical University from 2008 to 2015 was performed. There were 234 males and 15 females, aged from 60 to 88 years. The clinical characteristics, treatment information and follow-up data were collected. ACCI was used to score the comorbidities of the patients. Receiver operating characteristic (ROC) curve was drawn and the patients were divided into high ACCI group and low ACCI group according to the cut-off value of ACCI. Prognostic factors were analyzed. Kaplan-Meier method was used for survival analysis, rank sum test was used for comparison between groups, χ2 test was used for enumeration data. Results: Overall survival (OS) was 54.6%, progression-free survival (PFS) was 59.4%, and cancer-specific survival (CSS) was 58.6%. Both the median survival time and PFS time were 60 months. The best cutoff point of the ACCI group was 5. Cox multivariate analysis showed that ACCI was an independent risk factor for OS, PFS and CSS (OR=1.553, 1.499 and 1.534,respectively, all P<0.05). In the high ACCI group, OS (χ2=4.120 and 4.115,P<0.05) and CSS (χ2=4.510 and 5.009,P<0.05) of patients treated with surgery plus radiotherapy and patients with radiotherapy alone were better than those of patients with surgery alone (P<0.05). But in the low ACCI group, there was no significant difference in prognosis among the three treatment regimens (P>0.05). Conclusion: High ACCI offors important prognostic information for LSCC in patients over 60 years old, and can guide clinical treatment options.

Application of meticulous anatomy skills with straight bipolar electric coagulation forceps in thyroid surgery / 中华耳鼻咽喉头颈外科杂志

To compare the efficacies of the two techniques of "micro-hemostasis and micro-cutting" with straight bipolar electrocoagulation forceps and traditional clamp-ligation for hemostasia in thyroid surgery. A total of 228 patients who underwent surgical treatment for thyroid neoplasms in our hospital between January 2015 and December 2018 were retrospectively analyzed, including 50 males and 178 females, aged 23-68 years old. Of those, 150 cases as electric knife group received traditional thyroid surgery between January 2015 and December 2018 and 78 cases as bipolar electrocoagulation group received thyroid surgery by using the technique of bipolar electrocoagulation with meticulous anatomy between January 2018 and December 2018. The total operation time, single operation time, intraoperative hemorrhage, postoperative drainage volume on the first day, postoperative hoarseness and hypocalcemia were compared between the two groups. SPSS 16.0 was used to analyze the data. The total operation time and intraoperative hemorrhage in the bipolar electrocoagulation group were significantly lower than those in the electric knife group ((59.33±18.29)min (77.21±25.39)min, (14.83±9.22)ml (36.86±11.80)ml, all 0.01). The single operation time of the bipolar electrocoagulation group was shorter than that of the electric knife group((10.25±6.16) min (20.34±7.24)min, (16.25±7.15)min (35.68±8.25)min, (12.12±5.25)min (20.68±7.26)min, value was 3.948,16.262,8.238, all 0.01).There was no significant difference between the two groups in postoperative drainage volume on the first day (0.05) and the incidence of postoperative hoarseness (0.05), while the incidence of hypocalcemia in the bipolar electrocoagulation group(10.26%) was lower than that in the electric knife group(21.33%,χ(2)=4.353, 0.05). The fine dissection for thyroid operation can be achieved by using straight bipolar electrocoagulation tweezers. The use of "micro-hemostasis" and "micro-cutting" technique with bipolar electrocoagulation tweezers can greatly reduce intraoperative bleeding, operation time and postoperative complication.

Significance of selective neck dissection in patients with cN0 thyroid carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the significance of selective neck dissection in patients with cN0 thyroid carcinoma who have a high-risk of lateral neck lymph node metastasis.</p><p><b>METHODS</b>Sixty three patients with cN0 thyroid carcinoma who have a high-risk of lateral neck lymph node metastasis were prospectively studied at the Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between August 2006 and June 2011. The patients with cN0 thyroid carcinoma easy to occur neck lymph node metastasis include: The maximum diameter of primary tumor is ≥ 2 cm; The primary tumor invaded the thyroid capsule; Lymph node metastasis in level VI is found; Lymph node enlargement in level III or/and IV were detected preoperatively by ultrasonography, but not considered as metastasis. The surgical procedure is that the selective neck dissection in level III and IV is performed depending on the collar incision of thyroid surgery. The lymph node chosen from the specimen has a frozen section. If lymph node metastasis is found in the frozen section, a functional neck dissection should be performed through prolonging the collar incision.</p><p><b>RESULTS</b>All cases were pathologically confirmed as thyroid papillary carcinoma. The occult metastasis rate of lateral neck lymph nodes was 39.7%. According to the univariate analysis, the patients with thyroid capsule invasion and lymph node metastasis in level VI were more likely to have lateral neck lymph node metastasis, and the occult metastasis rate was 46.9% and 54.3%, respectively (P = 0.028, P = 0.008), and there were statistically no significant difference in the primary tumor size and the preoperative neck lymph node status by ultrasonography with occult metastasis of lateral neck lymph nodes (P = 0.803 and P = 0.072). According to the multivariate analysis, there was a significant correlation only between the lymph node metastasis in level VI and occult metastasis of lateral neck lymph nodes (P = 0.017), but there was no significant correlation with the thyroid capsule invasion, primary tumor size and neck lymph node status by preoperative ultrasonography in prediction of occult metastasis of lateral neck lymph nodes (all P > 0.05).</p><p><b>CONCLUSIONS</b>Selective neck dissection is feasible for the patients with cN0 thyroid carcinoma who have a high-risk lateral neck lymph node metastasis and the lateral occult metastatic lymph node can be promptly found and removed. We suggest that the selective neck dissection for level III and IV should be routinely performed in cN0 thyroid carcinoma patients with thyroid capsule invasion and lymph node metastasis in level VI.</p>

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>

Minimally invasive endoscopy-assisted neck dissection to treat lateral cervical metastasis of thyroid papillary carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Traditional open surgery for lateral neck dissection for patients with papillary thyroid carcinoma (PTC) leaves an unsightly scar. It is necessary to apply small incision to complete lateral neck dissection with endoscopy-technique for PTC and to evaluate its feasibility and safety.</p><p><b>METHODS</b>Between March 2010 and May 2011, 6 cases of PTC with no definite lymph node metastasis at level II-IV and 12 cases of PTC at T1-T4 with definite lymph node metastasis at level II-V received minimally invasive endoscopy-assisted lateral neck dissection. After accomplishing thyroidectomy and central compartment dissection, ipsilateral level II-IV,VI orII-VI dissection via small neck incision was performed.</p><p><b>RESULTS</b>This procedure was carried out successfully in all 18 patients. The incision was 5 cm every patient. Postoperative pT1 was 5 cases, pT2 5 cases, pT3 6 cases, pT4 2 cases, pN0 5 cases, N1b 13 cases. Mean operative time for lateral neck dissection was 3.6 hours (ranging 2.5-5.0 hours). No significant blood loss or complications occurred. Thirteen patients showed lymph node metastases in both central or lateral neck. The mean number of harvested nodes was 33.1 (ranging 16-61). No residual or recurrent disease was found in 2-3 years follow-up time.</p><p><b>CONCLUSION</b>Minimally invasive video-assisted comprehensive neck dissection for metastatic papillary thyroid carcinoma is feasible and safe with excellent cosmetic results.</p>

Effects of sorafenib and liposome doxorubicin on human poorly differentiated thyroid carcinoma xenografts in nude mice / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the therapeutic effects of sorafenib and liposome doxorubicin on poorly differentiated thyroid carcinoma (PDTC) xenografts in nude mice.</p><p><b>METHODS</b>Sorafenib and liposome doxorubicin were applied to PDTC xenografts in nude mice. The mice were randomized into seven groups: blank control (A), vehicle control (B), single liposome doxorubicin (C), single sorafenib group (D), liposome doxorubicin combined with low dose sorafenib group (E), combined group with medium dosage of sorafenib (F), combined group with high-dose of sorafenib(G). The volume, weight and growth inhibition rate of tumours were measured to evaluate the therapeutic effects of drugs.</p><p><b>RESULTS</b>Sorafenib and liposome doxorubicin showed significant antitumor activity in the PDTC xenografts. The mean tumor volumes of seven groups were (1274.13 ± 393.76) mm(3), (1060.00 ± 469.05) mm(3), (726.76 ± 488.22) mm(3), (451.54 ± 97.75) mm(3), (518.37 ± 164.44) mm(3), (310.51 ± 210.53) mm(3), and (228.44 ± 129.21) mm(3), respectively. The mean tumor weights of the seven groups were (1.13 ± 0.42)g, (0.91 ± 0.39)g, (0.78 ± 0.45)g, (0.55 ± 0.17) g, (0.52 ± 0.19) g, (0.34 ± 0.21) g, and (0.19 ± 0.09) g separately. The tumor inhibition rates of group C to G were 30.8%, 40.8%, 42.3%, 62.9%, 72.6% separately.</p><p><b>CONCLUSIONS</b>Sorafenib and liposome doxorubicin, no matter for single agent or in combination, showed significant antitumor activity in the PDTC PDTC xenografts in vivo. The tumour-inhibited effect of single sorafenib is better than that of single liposome doxorubicin. Liposome doxorubicin combined with medium dosage of sorafenib had a better therapeutic effect and less side effects.</p>

Cervical lymph node metastasis in clinical N0 papillary 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 nodes metastasis and the surgical managements of cervical lymph nodes in clinical N0 (cN0) papillary thyroid carcinoma.</p><p><b>METHODS</b>Fifty-one consecutive patients with papillary carcinomas without clinical evidence of cervical lymph node involvement were included in the study between August 2007 and September 2010, in which 53 sides underwent neck lymph node dissection. Preoperative lymphoscintigraphy intra-operative hand-held gamma probe detecting and blue dye technique were used to detect the sentinel lymph node (SLN). SLNs were sent to frozen-section and the results were compared with specimen of routine selective neck dissection. All the pathologic specimens were reviewed by pathologists, counting the numbers of pathologic positive nodes and mapping the localization of positive nodes in level II, III, IV, V and VI respectively. The following criteria were used to study the predictive value of lateral neck compartment lymph node metastasis: age, multifocality of the tumor, extracapsular spread (ECS), tumor size, and the number of central compartment metastasis nodes. Univariate analysis with the χ2 test was used to analyze the statistical correlation between lateral neck compartment lymph node metastasis and the other clinical factors. Multiple logistic regression analysis was used to identify the multivariate correlates of lateral neck compartment metastasis.</p><p><b>RESULTS</b>The occult lymph node metastasis and lateral neck metastasis rates were 77.4% and 58.5% respectively, central compartment metastasis ≥3 nodes was the only independent predictive factor for the metastasis in lateral neck. Twelve sides were pN0 and other 41 sides were pN+ in all 53 side specimens. Of 41 sides with pN+, 17 sides (41.5%) involved single site and 24 sides (58.5%) involved multi-sites. The distribution of metastasis lymph nodes:level VI 62.3%, level III 52.8%, level IV 30.2%, level II 18.9%, and level V 0%.</p><p><b>CONCLUSIONS</b>Cervical occult lymph node metastasis in cN0 papillary thyroid carcinoma mainly localizes in level VI, level III, level IV and level II.Selective neck dissection including level VI, III, IV, II is enough for papillary carcinoma without clinical evidence of cervical lymph node involvement.</p>

Analysis of surgical treatment of papillary thyroid carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To present the treatment results and to analyze the causes of recurrence in patients with papillary thyroid carcinoma.</p><p><b>METHODS</b>A retrospective review of 600 patients with papillary thyroid carcinoma treated between 1994 and 1999 was conducted. The primary lesions were originated from the left lobe in 188 cases, the right lobe in 290 cases, the isthmus in 8 cases, and multicentric in 114 cases. From the 600 cases, 584 were well-differentiated and 16 poorly differentiated. TNM stage:385 cases of stage I, 37 cases of stage II, 17 cases of stage III, and 161 cases of stage IV. Three hundred and one patients was N1b stage. All patients received surgical treatment. Among them, 19 cases received radiotherapy, 71 received (131)I-therapy and one case received concomitant radiotherapy and (131)I-therapy.</p><p><b>RESULTS</b>There were 94 recurrent cases. Twenty-seven cases died of recurrence, metastasis and other diseases. The overall 10-year survival rate was 93.2%. The overall 10 year survival rates of stage I, II, III, and IV patients were 99.1%, 94.7%, 93.8%, and 78.5%, respectively (P < 0.01). The 10-year survival rate of lower-age group (< 45 years) was 99.4% and higher-age group (≥ 45 years) 82.1% (P < 0.01). The 10-year survival rate of patients with trachea invasion was 66.5%, significantly lower than the 95.1% in patients without trachea invasion (P < 0.01). The 10-year survival rate of well-differentiated cases was 94.9%, significantly higher than the 38.9% in the poorly differentiated cases (P < 0.01). Multivariate analysis showed that the TNM stage, differentiation degree and the thorough going surgical operation were independent risk factors for the prognosis of papillary thyroid carcinoma.</p><p><b>CONCLUSIONS</b>The TNM stage, differentiation degree and the thorough going surgical operation are independent risk factors for the prognosis of papillary thyroid carcinoma.</p>

Surgical treatment and prognosis analysis on medullary thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the clinical characteristics, the surgical treatments and the prognostic factors of medullary thyroid carcinoma.</p><p><b>METHODS</b>Eighty-two cases of medullary thyroid carcinoma undergoing surgeries between January 1999 and December 2004 were reviewed. There were 39 males and 43 females. Age ranged from 16 to 77 years old, with a median of 46 years old. The calcitonin, chromogranin A and neuron-specific enolase were analysed by immunohistochemistry in samples, and calcitonin was detected in 24 cases. Of them, 28 cases underwent lobectomy with isthmectomy, 24 for remained lobe dissection, 16 for total thyroidectomy, and 14 only for neck and upper mediastinal lymph node dissection. Of the 82 cases, 68 cases underwent trachea esophageal ditch dissection, 53 for unilateral neck dissection, 11 for bilateral neck dissection, 13 for upper mediastinal lymph node dissection through trans-cervical approach, and 5 for mediastinal lymph node dissection through inverted T-shaped incision.</p><p><b>RESULTS</b>Immunohistochemical examination revealed that the expression rates of calcitonin, chromogranin A and neuron-specific enolase were 95.8%, 88.9% and 80.0% respectively. Total metastasis rate of neck lymph nodes was 68.8%, and the rates in level II, III, IV, V and VI were 27.3%, 47.7%, 59.1%, 11.4% and 52.3% respectively. The overall five-year survival rate was 87.8%. The recurrent rate of contralateral lobes was 5.8% and local recurrent rate was 7.3% respectively. Univariate analysis showed that gender, age and TNM stage were significant prognostic factors. Multivariate analysis revealed that distant metastasis was an independent prognostic factor.</p><p><b>CONCLUSIONS</b>Standard radical surgery of the primary and metastatic lesion is key to the treatment of medullary thyroid carcinoma. Lobectomy with isthmectomy should be applied to sporadic medullary thyroid carcinoma, with regular postoperative follow-up, and total thyroidectomy to familial or bilateral medullary thyroid carcinoma. Therefore, detecting the calcitonin is very important for medullary thyroid carcinoma patients' prognosis.</p>

Free tissue transfer for skull base reconstruction of advanced oncological defects / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the results and the indications of free flaps in the skull base reconstruction.</p><p><b>METHODS</b>A retrospective review was performed of 25 free flaps reconstructions for skull base tumor ablation defects between March of 1999 and March of 2009. There were 9 latissimus dorsi flaps, 6 rectus abdominis flaps, 4 deep inferior epigastric artery perforator flaps, 3 anterolateral thigh flaps, 2 radial forearm flaps and 1 fibular flap. The defects were classified as cranial bone (100%), dura (40%), brain (12%), sino-nasal cavity (52%), mucosa (56%) and skin (80%).</p><p><b>RESULTS</b>Twenty-three of 25(92%) free flaps survived. One total flap failure and 1 partial flap failure occurred. Five patients (20%) had central nervous system related postoperative complications which including 1 mortality, 2 central nerve system infection and 2 cerebrospinal fluid fistula.</p><p><b>CONCLUSIONS</b>Free flaps transfer is a reliable reconstruction technique for cranial base surgery. This provides a solution to the select advances disease otherwise surgical contraindications. Free flap is the choice for reconstruction of advanced oncological defects, especially when skin and mucosa are violated.</p>

Sentinel lymph node biopsy in papillary thyroid cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the reliability and feasibility of sentinel lymph node biopsy (SLNB) of papillary thyroid carcinoma using combination of lymphoscintigraphy, the gamma probe and methylene blue staining techniques.</p><p><b>METHODS</b>Twenty-three consecutive patients with thyroid papillary carcinoma were entered in the study between August 2007 and August 2009. All cases were without clinical evidence of cervical lymph node involvement. The (99)Tc(m)-dextran of 74 MBq (2mCi) was injected intratumorally under ultrasound guidance about 2 h to 5 h prior to surgery. Methylene blue was injected around the tumor during surgery. Preoperative lymphoscintigraphy, intra-operative hand-held gamma probe detecting and methylene blue staining techniques were used to detect the sentinel lymph node (SLN). SLN biopsies were sent to prepare frozen sections and the results were compared with specimen of routine selective neck dissection.</p><p><b>RESULTS</b>The SLNs were identified in all cases with the combination techniques. The SLN identification rates were 87.0% and 100% with methylene blue staining and lymphoscintigraphy plus probe scanning, respectively. Metastases in SLNs were revealed by frozen-section histology in 12 patients. In one case, SLNs frozen-section were negative, but metastasis was detected in routine histology. In other case both SLN and routine histology were negative, but metastasis was detected in non-SLN (level VI) neck dissection. The overall accuracy of the SLN biopsy was 91.3%, positive predictive value 100% and negative predictive value 81.8%.</p><p><b>CONCLUSION</b>The results seem the SLN biopsy technique is a feasible and valuable method for detecting cervical lymph node metastasis and is helpful to decide performing neck dissection in patients with cN0 papillary thyroid carcinoma.</p>

Role of parathyroid hormone measurement in prediction for symptomatic hypocalcaemia after total thyroidectomy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the role of parathyroid hormone (PTH) and serum calcium in prediction for hypocalcaemia after total thyroidectomy.</p><p><b>METHODS</b>One hundred and sixty-five patients undergoing total or complete total thyroidectomy were reviewed retrospectively. The indications included bilateral carcinoma, undifferential carcinoma, surroundings invasion, distant metastasis and huge benign lesions. Preoperative and postoperative PTH, calcium concentrations and their decline levels were compared between Jan. 2005 and May 2009. The role of PTH value and decline level predicting for symptomatic hypocalcaemia were analyzed by receiver operator characteristics (ROC) curve.</p><p><b>RESULTS</b>After total thyroidectomy, 85 patients (51.5%) developed hypocalcemia. Symptoms were reported by 36 patients (21.8%). The mean concentration of PTH for normocalcaemia (80 cases), asymptomatic hypocalcaemia (49 cases) and symptomatic patients (36 cases) were 31.0 ng/L, 19.6 ng/L and 11.9 ng/L, respectively. The mean decline level for the three groups were 28.6%, 52.6% and 78.0%, respectively. PTH value and its decline level had a poor predicting value for symptomatic hypocalcaemia and high negative predicting value for asymptomatic patients. The serum calcium concentration more than 2.0 mmol/L, PTH level higher than 15 ng/L and PTH decline less than 50% had the good negative predicting value of 97.6%, 90.3% and 96.5%, respectively.</p><p><b>CONCLUSIONS</b>Postoperative PTH and its decline level were significantly correlated with postoperative serum calcium concentration but had a low accuracy for predicting symptomatic hypocalcaemia. The serum calcium concentration more than 2.0 mmol/L, PTH level higher than 15 ng/L and PTH decline less than 50% had the good predicting value for asymptomatic patients. Calcium should be routinely supplemented in the first 24 h after total thyroidectomy to reduce the rate of hypocalcemia and the severity of hypocalcemia symptoms.</p>

Clinical analysis of 60 cases with maxillary squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the clinical characters, treatment modalities and prognosis of patients with maxillary squamous cell carcinoma.</p><p><b>METHODS</b>The clinical data of 60 patients with maxillary squamous cell carcinoma treatment between January 1994 and December 2004 were analyzed retrospectively. The patients were treated with three therapy modalities including radiotherapy alone (22 cases), radiotherapy and surgery (R + S, 29 cases) and concurrent chemo-radio-therapy adjuvant surgery (CCR + S, 9 cases).</p><p><b>RESULTS</b>The five year survival rate were 18.2%, 51.7% and 33.3% for patients in the radiotherapy alone group, the R + S group and the CCR + S group, respectively. Patients receiving R + S combined modality therapy had a significantly higher five year survival rate than the patients who were treated radiotherapy alone (χ(2) = 15.62, P < 0.01). The five year survival rate (51.7%) of patients in R + S group was significantly higher than that (33.3%) of patients in CCR + S group (χ(2) = 4.28, P < 0.05), and also higher than that (18.2%) of patients in radiotherapy group (χ(2) = 9.49, P < 0.01).</p><p><b>CONCLUSIONS</b>The combined therapy of radiation and surgery was a good choice of treatment for the patients with maxillary sinus squamous cell carcinoma. The role of concurrent chemo-radiotherapy adjuvant surgery in the treatment of maxillary sinus squamous cell carcinoma needs further to research.</p>

Application of an extended collar incision in neck dissection for differentiated thyroid cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore a cosmetic incision in the neck dissection for differentiated thyroid carcinoma.</p><p><b>METHODS</b>An extended collar incision was used for neck dissection in 82 consecutive patients with thyroid carcinoma from May 1999 to December 2006. The incision was designed to start as a conventional thyroid collar incision, and then to extend it along the skin crease to the anterior border of trapezium, so to avoid the vertical limb of conventional hockey stick incision. There were 60 females and 22 males in this series, with a median age of 40.5 years (range, 10 to 80 years). Ninety-six procedures of neck dissection were performed in 82 patients, including one radical neck dissection, one type I modified neck dissection, 8 type II modified neck dissections, and 86 type III modified neck dissections.</p><p><b>RESULTS</b>The average time of anesthesia was 197 minutes. The average dissected lymph nodes were 37.5, with average metastasis in 8.8 nodes. Eight patients (9.8%) developed complications related to neck dissection. The follow-up period in these patients were 1 to 96 months with a median follow-up time of 23 months. Cervical recurrence was found in only one patient (1.2%). Neither death nor distant metastasis was observed in this series.</p><p><b>CONCLUSION</b>It is feasible to perform a modified neck dissection for differentiated thyroid cancer through the extended collar incision. The preliminary results show that the above described incision is not only oncologically safe, but also offers a cosmetic benefit for the patient with thyroid carcinoma.</p>