The role of intraoperative frozen section of central neck lymph nodes in the management of patients preoperatively diagnosed with low- risk differentiated cancer.

INTRODUCTION: Histological examination during surgery (FS) has a place in the surgical management of differentiated thyroid carcinoma (DTC). Extending the indication for limited surgery to 4 cm tumor size (ATA guidelines 2015) cytologically verified DTCs, increases the emphasis on accurate patient selection. In our work, we reflected on the effectiveness of FS and its relationship to optimal patient management. METHODS: In a single-center retrospective study, we evaluated the documentation of patients indicated for primary surgery for DTC from January 1, 2016 to December 31, 2020 - there was 489 patients collectively, 121 were men, median age was 50 years (1681), 73 patients (female, age 1845 years) with preoperatively identified low-risk DTC (size 1140mm) were indicated for lobectomy. RESULTS: 34 patients (46.6%) did not meet the criteria for limited surgery 15 patients were identified from FS of the lymph nodes of the central compartment (LNCK) (15 of 25 patients) - 1 patient with false negative result and 6 patients with FS of the thyroid gland (SH) (6 / 41) - 11 patients with false negative findings. Two-step OP surgery was performed on 13 patients (17.8%). FS of LNCK identified high-risk cancer and reduced the risk of two-step surgery compared to the group of patients in whom FS was not performed or was performed from thyroid gland. The difference was statistically significant (OR 1.93, p=0.026). CONCLUSION: Approximately ½ of the patients from preoperatively identified low-risk cancers in our cohort met the criteria for limited surgery. About 30% of them eventually needed a two-step operation. Perioperative examination of LNCK helps to perform radical surgery at one time.

Thyroid surgery in children: our experience.

INTRODUCTION: Thyroid surgery in children is a rare operation. The aim of our paper is to point out the specifics of thyroid surgery in children. METHODS: Retrospective analysis of patients hospitalized at the Department of Paediatric Surgery, Faculty of Medicine, Comenius University and National Institute of Childrens Diseases in Bratislava during a 10-year period (20072016) who underwent thyroid surgeries. RESULTS: The retrospective analysis included 81 patients: 66 (81%) girls and 15 (19%) boys. The mean age of the patients was 14 years ±8 months (range 418 years). The most common indications for thyroid surgery were: a nodule in 36 (44.4%) patients, Graves Basedow thyrotoxicosis in 19 (23.5%) patients, and suspected thyroid carcinoma in 11 (13.6%) patients. Cervical lymph node metastases (mts) were diagnosed in 9 (11.1%) patients, and distant pulmonary metastases in 5 (6.17%) patients. Total thyroidectomy (TTE) was performed in 43 (53%) patients, total lobectomy (TL) in 20 (24.7%) patients. Extended surgery on regional lymph nodes was performed in 9 (11.1%) patients. Eight (9.9%) patients underwent reoperation. A total of 12 (14.8%) patients experienced postoperative complications. Unilateral transient recurrent laryngeal nerve (RLN) paralysis occurred in 2 patients, and permanent in one patient. Transient postoperative hypoparathyroidism with hypocalcaemia was reported in 8 (9.9%) patients; no permanent condition of this type was observed. CONCLUSION: Multidisciplinary collaboration ensures that optimal surgical results are achieved in the patients. Experience of the surgeon performing thyroid surgery in children remains crucial.

A different prognostic value of BRAFV600E mutation positivity in various age groups of patients with papillary thyroid cancer.

The aim of the retrospective single-center study was to assess the prognostic value of BRAFV600E mutation positivity (BRAFV600E+) on disease persistence/recurrence in patients with papillary thyroid cancer (PTC). A total of 199 patients having had initial surgery with neck dissection in our hospital between 6/2009-6/2012 were included in the cohort. Excluded were patients with unifocal microcarcinoma ≤1cm. BRAFV600E mutation was tested from formalin-fixed paraffin-embedded surgicaly removed tumors. All included patients were postoperatively treated with radioiodine. The median duration of follow-up was 43 months, quartiles range 30 - 58 months. Variables included in the final model: BRAFV600E+, categorised age, sex, and high-risk status, or alternatively lymph node status. Based on differences in persistence/recurrence rates, patients were divided into three age categories (<35, 35-60, ≥60). Multiple regression analysis showed a significant interaction between BRAFV600E+ and age, modifying the effect of BRAFV600E+ on persistence/recurrence. BRAFV600E+ in low-risk patients of any age and in high-risk middle-aged patients did not confer additional hazard compared with BRAFV600E mutation negative (BRAFV600E-) low-risk and BRAFV600E- high-risk patients, respectively. However, younger (<35 years) and older (≥60 years) high-risk BRAFV600E+ patients had 17.28 and 33.49-fold increased hazard of persistence/recurrence, respectively, compared with low-risk BRAFV600E- patients. The alternative model including lymph node status yielded similar results for the prognostic significance of BRAFV600E+ in younger and older patients. In conclusion, the prognostic value of BRAFV600E+ depends on high-risk status and likely on age-associated factors. Such additional knowledge could change clinical decision-making in treatment modality.

Laparoscopic cholecystectomy in children.

UNLABELLED: In 95 children (age 6-18 y) treated for gallstones between 2002-2010, 95 laparoscopic cholecystectomies were carried out. Symptomatic cholecystolithiasis was the indication for laparoscopic cholecystectomy in most of the cases. In three patients, there was a conversion to open cholecystectomy. Postoperative complications due to failure of bile drainage arose in three patients. Restored bile drainage was secured for two biliodigestive anastomosis. Bile leak in a third patient solved a temporary biliary stent. Laparoscopic cholecystectomy is the gold standard for gallstones (Ref. 8). KEYWORDS: gallstones, laparoscopic cholecystectomy, cholecystolithiasis, bile drainage.

[Ductal carcinoma in situ (DCIS) and biopsy of the sentinel lymph node]. / DCIS a biopsia sentinelovej uzliny.

INTRODUCTION: Ductal carcinoma in situ (DCIS) is the disease with increasing incidence. Nowadays, approximately 80% DCIS are diagnosed via mammography and represent more than 20% of all types of breast cancer. The acceptance of surgical procedures with this type of breast carcinoma is controversial as primary diagnosis of non-invasive carcinoma is often underestimated and in the end, histopathological examination reveals invasive carcinoma with biological potential to metastasize. In cases of "risk" patient groups with DCIS, several studies report lymph node metastases. The aim of the study has been to assess the incidence of sentinel lymph node metastatic involvement in high-risk patient group with DCIS and in ductal carcinoma in situ with microinvasion (DCISMI), to note the incidence of invasive carcinoma in definitive histopathology in patients with pre-operative diagnosis of DCIS and to analyze some predictors of invasivity. STUDY TYPE AND PATIENT GROUP: In retrospective analysis, we evaluated the setting of 119 patients who have been operated on at our Clinic from January, 1st 2008 until December, 31th 2010 for the diagnosis of DCIS. Prospectively, we have created the setting of 44 patients with high-risk DCIS with sentinel lymph node biopsy (SLNB) performed. METHODS AND RESULTS. Metastatic involvement of sentinel lymph node in high-risk DCIS has been found in 4 cases (9.0%)--in 1 patient (2.2%) with correct diagnosis of DCIS and in 3 patients (6.8%) with invasive carcinoma according to final histopathology. In the patient with DCIS, a micrometastasis of 0.4 mm was found in one sentinel lymph node. After complete axillary dissection, non-sentinel axillary lymph nodes metastatic involvement was not demonstrated (14/0). In 6 cases (5.0%), we identified DCISMI and did not find metastasis in sentinel lymph node. In the high-risk DCIS group, in 4 patients (9.0%) DCISMI and in 12 patients (27.2%) invasive carcinoma was found after definitive histopathologic examination. In this group, the overall ratio of invasive lesions was 36.2%. As for predictors of invasivity, high-grade carcinoma (OR 4.2; 95% CI 1,40-12,58) has more than 4-fold higher influence and lesion size

[Central cervical dissection of lymph nodes in the management of differentiated thyroid carcinoma--our experience]. / Centrálna krcná disekcia lymfatických uzlín v liecbe diferencovaného karcinómu stítnej zl'azy--na e skúsenosti.

INTRODUCTION: Total thyroidectomy (TTE) with central compartment lymphonodes (LU) dissection remains a standard procedure in the treatment of differentiated thyroid carcinomas. METHODOLOGY: The retrospective study assessed a group of patients undergoing primary or secondary procedures in our clinic. PATIENT GROUP: From 01.01. 2005 to 31. 07. 2007, a total of 50 patients underwent primary procedures, TTE with dissection of central compartment lymphonodes was performed in 18 patients, 58 patients were reoperated for relapses of the disorder. In the primary procedures, the central compartment lymphonodes were affected with increased rate, proportionally to a T-stage of the disorder 28% (T1), 52 (T2), 58% (T3). Multifocal carcinoma was associated with a high risk, where metastatic lymphadenopathy occured in 53% of the cases. In the reoperated subjects, relapses of the disorder were recorded in 78% of the patients in their central compartment lymphonodes and their thyreoglobulin levels decreased. Out of 126 patients, paresis of the nervus laryngeus reccurens was recorded in 4 subjects (3.1%) and postoperative hypoparathyreosis in 14 subjects (11%). CONCLUSION: Dissection of lymphonodes is a standard part of the surgical management of differentiated carcinomas, providing local control of the disease. 78% of the relapses were located within the central compartment. Risk and complication rates correspond to those reported in total thyroidectomy.

[Completion of total thyroidectomy for a differentiated thyroid carcinoma]. / Dokoncenie totálnej tyreoidektómie pre diferencovaný karcinóm stítnej zl'azy.

Total thyroidectomy with dissection of the central compartment (CK) lymphatic nodes is a standard surgical procedure in differentiated thyroid carcinomas. A minority of the patients are diagnosed postoperatively. Our study reports on surgical tactics in these patients. During 2003-2006, 47 patients were operated, to have total thyoidectomy performed. The patients' data were assessed retrospectively.

Is local excision due to rectal carcinoma a safe operation?

Though the treatment of patients with polypoid lesions of rectum is most frequently based on endoscopic approach, there are many cases that cannot be solved endoscopically and therefore must be treated by surgeons. In the past there were several possibilities of how to operate. In reachable localisations even local operation could be performed, however with varying measures of local recurrences and survival. The aim of this article is to draw attention to the complex topic of local excisions for rectal neoplasms and at the same time to analyse the review of indication criteria and evaluate the drawbacks of this operative method in our conditions (Tab. 3, Fig. 1, Ref 14).

[Radiation navigated reoperations of the thyroid gland in differentiated carcinoma]. / Radiacne navigované reoperácie stítnej zlazy pre diferencovaný karcinóm.

Radiation-navigated reoperations of the thyroid gland for the differenciated carcinoma are reserved for such cases of the thyroid gland reoperations aiming to complete a total thyroidectomy and, also, to extirpate metastatically affected lymphonodes. The authors discuss this part of the above surgical procedure, its therapeutic prospects, as well as its cons. They recommend already the primary surgical procedure on the thyroid gland to be conducted carefully--i.e. to conduct at least a lobectomy of the thyroid gland followed by visualization and examination of the recurrent laryngeal nerve and the parathyroid glands. They recommend the reoperations to be concentrated in specialized centres.

[Completing total thyroidectomy with lymph node dissection using a scintillation probe--case report]. / Dokoncenie totálnej tyroidektómie s disekciou lymfatických uzlín za pomoci scintilacného detektora--kazuistika.

Surgery remains the basic therapeutical method of the thyroid gland papillary carcinoma treatment. It is complemented by the adjacent thyro-eliminating therapy. A remarkable number of the thyroid gland carcinoma cases is still being diagnosed accidentally during the surgery for the thyroid gland benign disorders. The above mentioned patients, then, must undergo a reoperation, in order for the total thyroidectomy (TTE) and the lymphonodes dissection (LU) to be finished. The reoperations should be conducted in specialized clinics by sufficiently proficient teams. Our study reviews a case of a patient who underwent three surgeries on his thyroid gland.

[Surgical treatment of thyroid gland carcinoma--a 5-year retrospective study]. / Chirurgická liecba karcinómov stínej zlazy--5-rocná retrospektívna stúdia.

The authors analyze a group of 916 patients who had thyroid operations in the course of five years at a Surgical Department in Bratislava. 256 patients suffered from malignant disease. The authors analyze the incidence of different histological types of carcinoma, types of surgical operations, complications and patient survival. They discuss the problem of thyroid microcarcinoma, the relationship of Hashimoto's thyroiditis and carcinoma. The authors emphasize the importance of exact implementation of the first operation of the thyroid gland, in their opinion leaving residues of the gland during Berry ligature is inadequate. Re-operations should be implemented by departments with a high professional standard of surgeons and standardized pre- and postoperative patient care, in collaboration with an endocrinologist, pathologist and a department of nuclear medicine.